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Reported risk factors for and triggers of this condition include advanced age&#44; physical and&#47;or psychological stress&#44; and the immunodepression caused by AIDS&#44; transplantation&#44; cancer&#44; autoimmune diseases&#44; and immunosuppressive treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a> Reactivation of VVZ leads to transient viremia that is rapidly controlled by the acquired immune system and usually presents with pain and vesicles in the affected dermatome&#46; Viral particles occasionally reach skin at some distance from the affected dermatome to produce aberrant vesicles &#40;&#60;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#8211;6</span></a> When viremia persists&#44; it increases the probability of visceral involvement&#44; and &#62;<span class="elsevierStyleHsp" style=""></span>20 vesicles can appear at sites outside the initial dermatome and&#47;or affect &#62;<span class="elsevierStyleHsp" style=""></span>2 contiguous or noncontiguous dermatomes&#46; In this case&#44; the disease is known as disseminated herpes zoster &#40;DHZ&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;7&#8211;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The percentage of cases of DHZ reported in the literature varies&#44; although it is believed to be as high as 40&#37; in immunocompromised patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#8211;6&#44;10&#8211;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">DHZ is thought to present more often in immunocompromised patients&#44; with severe clinical outcome and greater mortality&#44; although it has been reported exceptionally in immunocompetent patients&#46; The objectives of the present study were to describe the demographic and clinical characteristics&#44; predisposing factors&#44; clinical presentation&#44; laboratory findings&#44; and clinical course of patients with DHZ and to compare findings between immunocompromised and immunocompetent patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">Retrospective observational study of adult patients admitted to a tertiary hospital&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Population</span><p id="par0030" class="elsevierStylePara elsevierViewall">The electronic clinical records of patients admitted with suspected DHZ between February 2010 and October 2015 were reviewed&#46; The inclusion criteria were age &#62;17 years&#44; previous examination by a dermatologist&#44; fulfillment of the clinical criteria for DHZ&#44; and virological confirmation by detection of the antigen using direct immunofluorescence or polymerase chain reaction &#40;PCR&#41; based on a swab sample of the vesicles&#46; Patients were followed for 3 months after diagnosis&#46; Cases of suspected DHZ&#44; where the presence of VVZ could not be confirmed&#44; were excluded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Measurements and Variables Studied</span><p id="par0035" class="elsevierStylePara elsevierViewall">The electronic clinical histories were reviewed&#46; Demographic data and clinical characteristics were obtained from a secondary electronic database&#46; Data were retrieved by 2 independent operators and reviewed by the principal investigator in order to detect erroneous values and missing information&#46; The specific data recorded were age&#44; sex&#44; preexisting baseline comorbidities and comorbidities diagnosed after onset of DHZ&#44; factors that triggered physical or psychological stress&#44; previous immunosuppressive treatment&#44; clinical characteristics at onset&#44; and laboratory variables&#46; Patients were considered to be immunocompromised if their underlying disease or treatment led to alteration of cellular and&#47;or humoral immunity&#44; namely&#44; treated or untreated HIV infection&#44; solid organ transplantation managed with immunosuppressive treatment&#44; hematologic-oncologic disease or solid organ tumors treated or not treated with chemotherapy&#44; diseases requiring treatment with more than 20<span class="elsevierStyleHsp" style=""></span>mg of prednisone for 2 weeks &#40;eg&#44; autoimmune diseases or pulmonary fibrosis&#41;&#44; and hypogammaglobulinemia &#40;agammaglobulinemia&#41;&#46; We also recorded outcome&#44; associated symptoms&#44; early and late complications &#40;including postherpetic neuralgia at 3 months after the initial symptoms&#41;&#44; and death during admission&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical Analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The baseline characteristics of the population were expressed using percentages for the categorical variables and the median &#40;IQR&#41; for continuous variables&#46; The baseline characteristics of patients with a clearly defined predisposing cause of DHZ were compared with those of patients with no trigger&#46; The Fisher exact test was used for categorical variables and the Mann-Whitney test for continuous variables&#46; Statistical significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We reviewed the clinical histories of 80 patients who had been admitted with suspected DHZ&#46; During the study period&#44; 41 patients fulfilled the inclusion criteria&#44; with confirmation of VVZ by direct immunofluorescence assay or PCR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">As for demographic characteristics &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; 20 patients &#40;48&#46;78&#37;&#41; were women&#44; and the median age was 70 &#40;52-82&#41; years&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Immunodepression was recorded in 24 patients &#40;58&#46;54&#37;&#41;&#46; Some patients had more than 1 comorbid condition that affected their immune response &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The most frequent causes of immunodepression were solid organ transplant &#40;7 patients &#91;17&#46;07&#37;&#93;&#41; and hematologic-oncologic diseases &#40;6 patients &#91;14&#46;63&#37;&#93;&#41;&#44; whereas autoimmune diseases&#44; treatment of solid tumors&#44; and HIV infection affected 4 patients each &#40;9&#46;76&#37;&#41;&#46; One patient was receiving corticosteroids for treatment of idiopathic pulmonary fibrosis&#46; A total of 17 patients &#40;41&#46;46&#37;&#41; were receiving corticosteroids or chemotherapy&#46; The search for immunodepression arising from DHZ revealed 1 case of HIV&#44; 1 neuroendocrine tumor of the ileum&#44; and 1 case of lymphoplasmacytic lymphoma&#46; Stress as a trigger factor &#40;severe infection&#44; major surgery&#44; or injury&#41; was detected in 16 cases &#40;39&#46;02&#37;&#41;&#46; Immunocompromised patients were significantly younger than immunocompetent patients &#40;median&#44; 60&#46;5 &#91;43&#46;5-70&#93; years vs 82 &#91;75-87&#93; years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Although triggers were less common in immunocompromised patients than in immunocompetent patients &#40;7 &#91;29&#46;17&#37;&#93; vs 9 &#91;52&#46;94&#37;&#93;&#41;&#44; the difference was not significant&#46; No frank immunodepression or stress as a trigger was detected in 8 cases &#40;19&#46;51&#37;&#41;&#44; although median age was higher in immunocompromised patients with stress factors than in immunocompetent patients with stress factors &#40;85 vs 77 years&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">As for clinical outcomes &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; the initial clinical manifestations were disseminated vesicles in 2 patients&#44; whereas in 39 patients &#40;95&#46;12&#37;&#41;&#44; onset of DHZ affected specific dermatomes before spreading to contiguous dermatomes &#40;25 cases&#41; and becoming disseminated &#40;14 cases&#41;&#46; Associated symptoms were observed in 26 patients &#40;63&#46;41&#37;&#41;&#46; Pain was the most frequent manifestation&#44; affecting half of all cases&#46; Less frequently&#44; symptoms were associated with burning sensation&#44; paresthesia&#44; and pruritus&#46; The classic clinical presentation took the form of clusters of vesicles with serous content on erythematous plaques&#46; The vesicles eventually ruptured&#44; leaving serous and hemorrhagic crusts or erosions in 29 patients &#40;70&#46;73&#37;&#41;&#46; On the other hand&#44; in 12 patients&#8212;4 immunocompetent &#40;23&#46;53&#37;&#41; and 8 immunocompromised &#40;33&#46;33&#37;&#41;&#8212;we observed atypical manifestations such as purulent or bloody vesicles&#46; The only immunocompromised patient who presented cutaneous necrosis during the course of the disease died &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; However&#44; analysis of the frequency of atypical clinical presentation revealed no statistically significant differences between the groups &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; Mucosal involvement was recorded in 12 patients &#40;29&#46;27&#37;&#41; and ocular involvement in 7 &#40;17&#46;07&#37;&#41;&#46; Fever&#44; which was not attributable to bacterial superinfection or other septic foci&#44; was recorded in 15 patients&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Of all the laboratory findings that could be attributed to DHZ&#44; the most outstanding was thrombocytopenia&#44; which was observed in 23 patients &#40;56&#46;10&#37;&#41;&#46; In almost half of these patients &#40;11 &#91;47&#37;&#93;&#41;&#44; thrombocytopenia reached moderate or severe values &#40;&#60;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;L and 50<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#44; respectively&#41;&#44; although no cases of hemorrhage were recorded&#46; Other findings included leukopenia &#40;13 patients &#91;31&#46;71&#37;&#93;&#41;&#44; anemia &#40;10 patients &#91;24&#46;39&#37;&#93;&#41;&#44; and asymptomatic alterations in liver biochemistry tests &#40;8 patients &#91;19&#46;51&#37;&#93;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Complications were recorded in 23 patients &#40;56&#46;10&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41; and affected immunocompromised and immunocompetent patients equally &#40;54&#46;17&#37; vs 58&#46;82&#37;&#41;&#46; Minimal differences were detected when both groups were compared&#44; although these were not statistically significant&#46; The most common complication was bacterial superinfection &#40;15 patients &#91;36&#46;59&#37;&#93;&#41;&#44; which was more frequent in immunocompromised patients &#40;10 patients &#91;41&#46;67&#37;&#93;&#41; than in immunocompetent patients &#40;5 &#91;29&#46;41&#37;&#93;&#41;&#46; The second most common complication was postherpetic neuralgia &#40;10 patients &#91;24&#46;39&#37;&#93;&#41;&#44; which was more common in immunocompetent patients &#40;5 &#91;29&#46;41&#37;&#93;&#41; than in immunocompromised patients &#40;5 &#91;20&#46;83&#37;&#93;&#41;&#46; Three patients had keratitis&#44; and 2 patients had meningoencephalitis with isolation of VVZ in cerebrospinal fluid by PCR&#46; With respect to outcome&#44; 35 patients &#40;85&#46;37&#37;&#41; were cured with systemic antiviral treatment&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">All patients were prescribed acylovir 10 to 15<span class="elsevierStyleHsp" style=""></span>mg&#47;kg tid administered intravenously or adjusted for renal function&#8212;at least until new lesions ceased to appear&#8212;before switching to oral treatment&#46; Treatment led to remission of symptoms in 35 cases &#40;85&#46;37&#37;&#41;&#46; Six patients &#40;14&#46;63&#37;&#41; died&#46; The 2 patients with meningoencephalitis died &#40;1 immunocompetent and 1 immunocompromised&#41;&#46; One immunocompromised patient died with suspected nervous system involvement&#44; although this was not confirmed&#44; as no lumbar puncture was performed&#59; the remaining 3 patients died of multiple intercurrent conditions&#46; No significant differences in mortality were recorded between immunocompetent patients and immunocompromised patients &#40;17&#46;65&#37; vs 12&#46;50&#37;&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Our study included only patients with DHZ&#44; who comprise the largest population with this disease reported to date&#46; We determined the epidemiology&#44; clinical manifestations&#44; and outcome of patients with DHZ and compared our findings between immunocompetent and immunocompromised patients&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Consistent with findings reported elsewhere&#44; our analysis of epidemiological data revealed no differences in the frequency of DHZ between the sexes&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a> The incidence of classic herpes zoster&#44; which affects only 1 dermatome&#44; has been shown to increase with age&#58; more than 66&#37; of patients with this disease are aged &#62;<span class="elsevierStyleHsp" style=""></span>50 years&#46; We reported the same finding in the patients with DHZ we studied&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;3&#8211;5&#44;7&#44;10&#44;11&#44;13&#8211;16</span></a> This association seems to be related to senescence&#44; or aging&#44; of the immune system&#46; Several studies have shown that the cellular immune response by lymphocytes stimulated in vitro through exposure to VVZ is diminished with age&#46; This phenomenon is known as immunosenescence&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3&#44;17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In the study carried out by Merselis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> between 1932 and 1962&#8212;the only one to analyze DHZ in both immunocompromised and immunocompetent individuals&#8212;of the 17 patients studied&#44; 11 &#40;65&#37;&#41; were considered immunocompromised because of diseases known at the time&#46; We found immunodepression-related diseases in 24 patients &#40;58&#46;54&#37;&#41;&#46; Consistent with the literature&#44; the causes of immunodepression we identified compromised cellular immunity&#44; with no cases involving alterations of humoral immunity&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#8211;4&#44;6&#44;12&#44;16&#44;18&#8211;24</span></a> DHZ was the first manifestation of an underlying immunodepressive systemic disease in 3 patients&#44; thus highlighting the importance of assessing predisposing comorbid conditions in patients with DHZ&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Cases of DHZ in immunocompetent patients are exceptional in the literature&#44; and no studies have evaluated the risk of dissemination of herpes zoster in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#8211;15&#44;25&#8211;27</span></a> The high percentage of cases of DHZ in immunocompetent patients that we found in our study suggests the possibility of dissemination in any patient with herpes zoster&#46; The statistically significant difference in age between immunocompetent and immunocompromised patients suggests that age per se could be a risk factor for DHZ&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;28</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In most of the cases of DHZ reported in the literature and in 95&#37; of patients in the present study&#44; the disease initially affected a specific dermatome before spreading to contiguous dermatomes or becoming disseminated&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> The vesicles that are typical of this disease can progress with suppuration&#44; hemorrhagic content&#44; or necrosis&#46; In contrast with our observations on age&#44; we found no significant differences between immunocompetent and immunocompromised patients with respect to clinical manifestations&#46; Only 1 immunocompromised patient had necrosis of cutaneous lesions&#44; which was associated with a poor prognosis due to a fatal outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;20&#44;21&#44;24</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The laboratory alterations caused by VVZ were reported during primary infection&#44; and we found that they are also frequent in DHZ&#46; Thrombocytopenia affected more than half of the patients and in some cases reached critical values&#46; Leukopenia&#44; anemia&#44; and altered liver biochemistry values were frequent&#46; Therefore&#44; it is important to monitor these laboratory parameters and to evaluate the mechanisms underlying the alterations owing to their potential clinical repercussions&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In a study of 1669 patients with classic nondisseminated herpes zoster&#44; complications were recorded in 28&#37; of cases&#44; with a significant difference between immunocompromised and immunocompetent patients &#40;20&#37; vs 9&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> In contrast&#44; among the patients with DHZ in our study&#44; in whom VVZ had spread across the skin&#44; the percentage who presented other&#44; additional complications was much higher&#44; and the complications affected both immunocompetent and immunocompromised patients equally&#46; The incidence of postherpetic neuralgia is 10&#37;-20&#37; in patients with herpes zoster and increases with age&#46; We recorded similar data for DHZ&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;10</span></a> Postherpetic neuralgia is caused by inflammation and necrosis of the sensory ganglia&#44; thus explaining the greater number of cases of this complication in immunocompetent patients&#44; who maintain the possibility of a more intense immune response&#46; However&#44; the difference between immunocompetent and immunocompromised patients was not significant&#46; The most severe complication we observed was meningoencephalitis&#44; which was fatal in 2 cases &#40;1 immunocompromised and 1 immunocompetent&#41;&#46; In contrast with findings from the literature&#44; no other complications &#40;eg&#44; motor involvement&#44; Ramsay-Hunt syndrome&#44; or vasculitis&#41; were detected&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23&#44;26&#44;28</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">All patients with DHZ received treatment with intravenous acyclovir&#46; Studies in immunocompromised patients show that the main risk factor for dissemination of VVZ is the time between onset of symptoms and treatment&#44; and a longer delay until initiation of treatment increases the risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;25&#44;29</span></a> Therefore&#44; in these cases it is necessary to start intravenous antiviral therapy early&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Our review of the literature revealed that the mortality of DHZ was 5&#37;-15&#37; in non&#8211;HIV-infected immunocompromised patients and 26&#37; in HIV-infected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> These findings were similar to ours&#46; Of note&#44; there were no differences in mortality between immunocompetent and immunocompromised patients&#44; thus indicating that this outcome could affect all patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study provides information on demographic characteristics&#44; underlying immunosuppression&#44; triggering factors&#44; clinical manifestations&#44; laboratory alterations&#44; and outcome in patients with DHZ&#46; We show that&#44; in the present study population&#44; the frequency of DHZ was similar in immunocompetent and immunocompromised patients&#46; In addition&#44; comparison of findings for both groups revealed significant differences in age&#44; although no significant differences were found for clinical manifestations&#44; outcome&#44; or mortality&#46; This finding highlights the important role of age in immunocompetent patients with respect to onset of the disease owing to immunosenescence&#46; It also shows that&#44; in both immunocompetent and immunocompromised patients&#44; onset of herpes zoster can take the form of disseminated disease&#46; Therefore&#44; the disease should be suspected in all patients irrespective of immune status&#44; and both diagnosis and treatment should be early&#46; Future studies could be performed to evaluate whether the vaccine that has been shown to prevent reactivation of VVZ and its potential complications could also be used to reduce the risk of dissemination by improving specific cellular immunity&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;14&#44;22&#44;24&#44;30</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical Disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of humans and animals</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no tests were carried out in humans or animals for the purposes of this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their institutional protocols on publication of patient data&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of Interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Herpes zoster"
            1 => "Disseminated herpes zoster"
            2 => "Immunocompromised host"
            3 => "Varicella zoster virus"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec804246"
          "palabras" => array:4 [
            0 => "Herpes zoster"
            1 => "Herpes zoster diseminado"
            2 => "Hu&#233;sped inmunocomprometido"
            3 => "Virus varicela zoster"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Shingles is the cutaneous expression of the reactivation of latent varicella zoster virus infection in sensory ganglia&#46; It presents as vesicles in the corresponding dermatome&#46; The condition is called disseminated herpes zoster &#40;DHZ&#41; when more than 2 contiguous dermatomes are affected&#44; more than 20 vesicles are observed outside the initial dermatome&#44; or involvement is systemic&#46; DHZ is rare and most frequently occurs in immunocompromised patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the epidemiology&#44; predisposing factors&#44; clinical presentation&#44; laboratory findings&#44; and clinical course of patients with DHZ&#44; and to compare the findings in immunocompromised and immunocompetent patients&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methodology</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analyzed a retrospective case series of adults hospitalized between February 2010 and October 2015&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Forty-one patients with virologically confirmed manifestations of DHZ were included&#46; Stress as a trigger factor was detected in 39&#37; and immunodepression in 58&#46;5&#37;&#46; Immunocompromised patients were younger than the immunocompetent patients &#40;mean ages&#44; 60&#46;5 vs 82 years&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; The 8 immunocompetent patients with no detectable trigger factors were older &#40;mean age&#44; 85 years&#41;&#46; In 95&#37; of cases&#44; DHZ was initially limited to a single dermatome and then spread to other dermatomes or became disseminated&#46; Thrombocytopenia was detected in 56&#37; of cases&#46; Complication rates were similar in immunocompromised and immunocompetent patients &#40;54&#37; vs 59&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; Six patients died&#59; there was no difference in mortality between the 2 groups&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study provides evidence on the relationship between DHZ&#44; the presence of underlying immunodepression&#44; and complications&#46; Immunosenescence may play an important role in the onset of this disease in older immunocompetent patients&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methodology"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El herpes zoster es la expresi&#243;n cut&#225;nea de la reactivaci&#243;n de una infecci&#243;n latente en ganglios sensitivos por el virus varicela zoster que se presenta con ves&#237;culas en el dermatoma correspondiente&#46; Cuando compromete m&#225;s de 2 dermatomas contiguos&#44; presenta m&#225;s de 20 ves&#237;culas por fuera del dermatoma inicial o tiene compromiso sist&#233;mico se denomina herpes zoster diseminado &#40;HZD&#41;&#46; Esta entidad es infrecuente y se suele presentar en pacientes inmunodeprimidos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir la epidemiolog&#237;a&#44; factores predisponentes&#44; cl&#237;nica&#44; laboratorio y evoluci&#243;n cl&#237;nica de pacientes con HZD&#46; Comparar hallazgos entre inmunodeprimidos e inmunocompetentes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Metodolog&#237;a</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio de una serie de casos retrospectiva&#44; en adultos ingresados entre febrero de 2010 y octubre de 2015&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 41 pacientes con cuadro cl&#237;nico de HZD y confirmaci&#243;n virol&#243;gica&#46; Se detectaron factores de estr&#233;s desencadenantes en el 39&#37; y de inmunodepresi&#243;n en el 58&#44;5&#37;&#46; Los inmunodeprimidos fueron m&#225;s j&#243;venes que los inmunocompetentes &#40;60&#44;5 vs 82 a&#241;os&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; En 8 casos sin inmunodepresi&#243;n ni desencadenantes se hall&#243; mayor edad &#40;85 a&#241;os&#41;&#46; En el 95&#37; de los casos el HZD comenz&#243; en dermatomas definidos&#44; y luego se extendi&#243; a otros o se generaliz&#243;&#46; El 56&#37; de los casos present&#243; trombocitopenia asociada&#46; Las complicaciones afectaron por igual a inmunodeprimidos e inmunocompetentes &#40;54&#37; vs 59&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Fallecieron 6 pacientes&#44; sin diferencias de mortalidad entre ambos grupos&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este estudio aporta evidencia sobre la relaci&#243;n entre el HZD&#44; la presencia de inmunosupresi&#243;n subyacente y las posibles complicaciones&#46; En pacientes inmunocompetentes&#44; por inmunosenescencia&#44; la edad podr&#237;a desempe&#241;ar un papel importante en la aparici&#243;n de esta enfermedad&#46;</p></span>"
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            "titulo" => "Objetivos"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Metodolog&#237;a"
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          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
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          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusi&#243;n"
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        ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Bollea-Garlatti ML&#44; Bollea-Garlatti LA&#44; Vacas AS&#44; Torre AC&#44; Kowalczuk AM&#44; Galimberti RL&#44; et al&#46; Caracter&#237;sticas cl&#237;nicas y evolutivas de una poblaci&#243;n con herpes zoster diseminado&#58; un estudio de cohorte retrospectiva&#46; Actas Dermosifiliogr&#46; 2017&#59;108&#58;145&#8211;152&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient flowchart&#46; DHZ indicates disseminated herpes zoster&#59; DIF&#44; direct immunofluorescence&#59; VVZ&#44; varicella zoster virus&#59; PCR&#44; polymerase chain reaction&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Predisposing factors found in patients considered immunocompromised &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#46; SOT indicates solid organ transplant&#59; HN&#44; hematologic neoplasm&#59; HIV&#44; human immunodeficiency virus&#59; AID&#44; autoimmune disease&#59; SON&#44; solid organ neoplasm&#59; IPF&#44; idiopathic pulmonary fibrosis&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Disseminated herpes zoster lesions involving both thighs of an immunocompromised patient&#46;</p>"
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Complications of disseminated herpes zoster &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;&#46; PHN indicates postherpetic neuralgia&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; DHZ&#44; disseminated herpes zoster&#59; IQR&#44; interquartile range&#59; HIV&#44; human immunodeficiency virus&#46;</p>"
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                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">Covariates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients With Confirmed DHZ &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Demographic characteristics</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Female sex&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Median &#40;IQR&#41; age&#44; y</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;52-82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Predisposing factors and triggers</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Predisposing factors&#44; No&#46; &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Solid organ transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hematologic neoplasm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Solid organ neoplasm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Untreated HIV infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Autoimmune disease under treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Idiopathic pulmonary fibrosis under treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Immunosuppressive treatment &#40;long-term corticosteroids or chemotherapy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stress factors No&#46; &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Medical cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Surgical cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Clinical features</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Onset&#44; specific dermatome&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Onset&#44; generalized&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Progression to more than 2 contiguous dermatomes&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Progression to disseminated disease&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Symptoms on presentation&#44; No&#46; &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pruritus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Burning sensation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clinical presentation&#44; No&#46; &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Classic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Atypical<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Purulent vesicles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hemorrhagic vesicles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Purulent and hemorrhagic vesicles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mucosal involvement&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ocular involvement&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fever</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&#44; <span class="elsevierStyleItalic">No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Laboratory values</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anemia&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Leukocytosis&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Leukopenia&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Thrombocytopenia&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mild &#40;100-150<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Moderate &#40;100-50<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Severe &#40;&#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Thrombocytosis&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alterations in liver values&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alterations in kidney function&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Specific complications</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No complications&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Complications&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bacterial superinfection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Postherpetic neuralgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Meningoencephalitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Keratitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleBold">Outcome</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;52&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;58&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;29&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;29&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;5&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;11&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;17&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Herpes zoster with dissemination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Singal"
                            1 => "S&#46; Mehta"
                            2 => "D&#46; Pandhi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian Pediatr"
                        "fecha" => "2006"
                        "volumen" => "43"
                        "paginaInicial" => "353"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16651676"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Varicella zoster virus immunity&#58; A primer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;J&#46; Duncan"
                            1 => "S&#46; Hambleton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jinf.2015.04.015"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Infect"
                        "fecha" => "2015"
                        "volumen" => "71"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S47"
                        "paginaFinal" => "S55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25917799"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zoster vaccine&#58; Current status and future prospects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Oxman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/653605"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "51"
                        "paginaInicial" => "197"
                        "paginaFinal" => "213"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20550454"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Humoral and cellular immunity to varicella-zoster virus&#58; An overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;M&#46; Arvin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/522123"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "197"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "S58"
                        "paginaFinal" => "S60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18419410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;P&#46; Yawn"
                            1 => "P&#46; Saddier"
                            2 => "P&#46;C&#46; Wollan"
                            3 => "J&#46;L&#46; St&#46; Sauver"
                            4 => "M&#46;J&#46; Kurland"
                            5 => "L&#46;S&#46; Sy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2007"
                        "volumen" => "82"
                        "paginaInicial" => "1341"
                        "paginaFinal" => "1349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17976353"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retrospective analysis of varicella zoster virus &#40;VZV&#41; copy DNA numbers in plasma of immunocompetent patients with herpes zoster&#44; of immunocompromised patients with disseminated VZV disease&#44; and of asymptomatic solid organ transplant recipients"
                      "autores" => array:1 [
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                          "autores" => array:6 [
                            0 => "A&#46; Kronenberg"
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                            2 => "R&#46;P&#46; Wuthrich"
                            3 => "C&#46; Cao"
                            4 => "S&#46; Lautenschlager"
                            5 => "N&#46;D&#46; Wiegand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-3062.2005.00106.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transpl Infect Dis"
                        "fecha" => "2005"
                        "volumen" => "7"
                        "paginaInicial" => "116"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16390399"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0185"
              "etiqueta" => "7"
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                    0 => array:2 [
                      "titulo" => "Varicella&#44; herpes zoster and dissemination"
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                          "autores" => array:2 [
                            0 => "G&#46;P&#46; Thami"
                            1 => "S&#46; Kaur"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.inf.0000057439.70183.c1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "295"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12634596"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0190"
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                    0 => array:2 [
                      "titulo" => "Bilateral disseminated herpes zoster in an immunocompetent host"
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                          "autores" => array:6 [
                            0 => "Y&#46; Takaoka"
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                            2 => "Y&#46; Yoshikawa"
                            3 => "M&#46; Tanioka"
                            4 => "A&#46; Fujisawa"
                            5 => "Y&#46; Endo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dermatol Online J"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24021372"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Varicella&#44; herpes zoster and dissemination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Gurvinder"
                            1 => "K&#46; Sukhjot"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.inf.0000057439.70183.c1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "295"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12634596"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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                      "titulo" => "Herpes zoster&#58; epidemiolog&#237;a y cl&#237;nica"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Vujacich"
                            1 => "E&#46; Poggi"
                            2 => "D&#46; Cecchini"
                            3 => "P&#46; Luchetti"
                            4 => "D&#46; Stamboulian"
                          ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Medicina &#40;B&#46; Aires&#41;"
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                        "volumen" => "68"
                        "paginaInicial" => "125"
                        "paginaFinal" => "128"
                      ]
                    ]
                  ]
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              ]
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              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical-epidemiological trends of herpes zoster&#58; A 5-year study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;E&#46; Br&#259;ni&#351;teanu"
                            1 => "G&#46; Stoleriu"
                            2 => "A&#46; Oan&#355;&#259;"
                            3 => "C&#46;M&#46; Dorob&#259;&#355;"
                            4 => "F&#46;D&#46; Petrariu"
                            5 => "D&#46;M&#46; Anchidin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Chir Soc Med Nat Iasi"
                        "fecha" => "2014"
                        "volumen" => "118"
                        "paginaInicial" => "817"
                        "paginaFinal" => "822"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25341306"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated herpes zoster"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;G&#46; Merselis"
                            1 => "D&#46; Kaye"
                            2 => "E&#46;W&#46; Hook"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "1964"
                        "volumen" => "113"
                        "paginaInicial" => "679"
                        "paginaFinal" => "686"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14120593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
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                0 => array:3 [
                  "comentario" => "pii&#58; 13030&#47;qt3cz2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>99b"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated varicella-zoster virus in an immunocompetent adult"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Petrun"
                            1 => "V&#46; Williams"
                            2 => "S&#46; Brice"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Dermatol Online J"
                        "fecha" => "2015"
                        "volumen" => "21"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A rare case of disseminated cutaneous zoster in an immunocompetent patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Gupta"
                            1 => "A&#46; Jain"
                            2 => "C&#46; Gardiner"
                            3 => "S&#46;K&#46; Tyring"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2296-6-50"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Fam Pract"
                        "fecha" => "2005"
                        "volumen" => "6"
                        "paginaInicial" => "50"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16351732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated zoster in an elderly patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Capron"
                            1 => "O&#46; Steichen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s15010-008-8287-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infection"
                        "fecha" => "2009"
                        "volumen" => "37"
                        "paginaInicial" => "179"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19169630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vaccination against herpes zoster and postherpetic neuralgia"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Shingles prevention study group"
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;N&#46; Oxman"
                            1 => "M&#46;J&#46; Levin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/522159"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "197"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "S228"
                        "paginaFinal" => "S236"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18419402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NK cells in healthy aging and age-associated diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "X&#46; Camous"
                            1 => "A&#46; Pera"
                            2 => "R&#46; Solana"
                            3 => "A&#46; Larbi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2012/195956"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Biomed Biotechnol"
                        "fecha" => "2012"
                        "volumen" => "2012"
                        "paginaInicial" => "195956"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23251076"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Case of disseminated vesicles of herpes zoster developing one day before the onset of local eruption in a hospitalized immunocompromised patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Mabuchi"
                            1 => "H&#46; Yamaoka"
                            2 => "M&#46; Kato"
                            3 => "N&#46; Ikoma"
                            4 => "S&#46; Tamiya"
                            5 => "H&#46;J&#46; Song"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tokai J Exp Clin Med"
                        "fecha" => "2013"
                        "volumen" => "38"
                        "paginaInicial" => "52"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23868735"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of human immunodeficiency virus infection initially presented with disseminated herpes zoster"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46;S&#46; Shin"
                            1 => "C&#46;H&#46; Na"
                            2 => "I&#46;G&#46; Song"
                            3 => "K&#46;C&#46; Choi"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5021/ad.2010.22.2.199"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Dermatol"
                        "fecha" => "2010"
                        "volumen" => "22"
                        "paginaInicial" => "199"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20548914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated herpes zoster in diabetes mellitus"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Graue"
                            1 => "S&#46; Grabbe"
                            2 => "J&#46; Dissemond"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2006-932529"
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                        "tituloSerie" => "Dtsch Med Wochenschr"
                        "fecha" => "2006"
                        "volumen" => "131"
                        "paginaInicial" => "384"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16479469"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            20 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated herpes zoster causing extensive skin necrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Appenzeller"
                            1 => "E&#46; Vinet"
                            2 => "A&#46; Clarke"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0961203308099633"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "paginaInicial" => "476"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19318405"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0260"
              "etiqueta" => "22"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fulminant VZV infection in an adult AIDS patient treated with steroids&#58; A case report"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
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                            1 => "A&#46; Baiocchini"
                            2 => "F&#46; del Nonno"
                            3 => "N&#46; Petrosillo"
                            4 => "V&#46; Galati"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcv.2014.02.008"
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                        "tituloSerie" => "J Clin Virol"
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                        "volumen" => "60"
                        "paginaInicial" => "63"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24631117"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0265"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Disseminated VZV infection and asymptomatic VZV vasculopathy after steroid abuse"
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                          "etal" => true
                          "autores" => array:6 [
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                            2 => "T&#46; White"
                            3 => "N&#46; Khmeleva"
                            4 => "A&#46; Heintzman"
                            5 => "P&#46;J&#46; Boyer"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Virol"
                        "fecha" => "2015"
                        "volumen" => "66"
                        "paginaInicial" => "72"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25866342"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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            23 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unusually extensive disseminated herpes zoster with multiple ulcer formation in a methotrexate-treated rheumatoid arthritis patient"
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                          "etal" => true
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                            2 => "T&#46; Funakoshi"
                            3 => "Y&#46; Fujio"
                            4 => "N&#46; Inoue"
                            5 => "S&#46; Takahashi"
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                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1346-8138.12377"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2014"
                        "volumen" => "41"
                        "paginaInicial" => "181"
                        "paginaFinal" => "182"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24433263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A rare case of disseminated shingles in an immunocompetent patient following a 7-day treatment with oral valacyclovir"
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "N&#46; Mendoza"
                            2 => "A&#46; Arora"
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                            4 => "A&#46; Gewirtzman"
                            5 => "A&#46;M&#46; Tremaine"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcv.2008.06.018"
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                        "tituloSerie" => "J Clin Virol"
                        "fecha" => "2008"
                        "volumen" => "43"
                        "paginaInicial" => "233"
                        "paginaFinal" => "235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18771948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0280"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated herpes zoster in an immunocompetent elderly patient"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;J&#46; Yoon"
                            1 => "S&#46;H&#46; Kim"
                            2 => "E&#46;H&#46; Lee"
                            3 => "J&#46;H&#46; Choi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3344/kjp.2013.26.2.195"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Pain"
                        "fecha" => "2013"
                        "volumen" => "26"
                        "paginaInicial" => "195"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23614086"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0285"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated herpes zoster in immunocompetent patients not due to varicella-zoster virus gene mutation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Z&#46;H&#46; Sun"
                            1 => "Y&#46;Y&#46; Guo"
                            2 => "M&#46; Li"
                            3 => "Z&#46;R&#46; Yao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Chin Med J &#40;Engl&#41;"
                        "fecha" => "2013"
                        "volumen" => "126"
                        "paginaInicial" => "3193"
                      ]
                    ]
                  ]
                ]
              ]
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            27 => array:3 [
              "identificador" => "bib0290"
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