Case and Research Letters
Primary Cutaneous Mucormycosis Due to Rhizopus arrhizus in an 8-Year-Old Girl
Mucormicosis cutánea primaria por Rhizopus arrhizus en una niña de 8 años
M.F. Albízuri-Prado
, A. Sánchez-Orta, A. Rodríguez-Bandera, M. Feito-Rodríguez
Autor para correspondencia
Servicio de Dermatología, Hospital universitario La Paz, Madrid, España
Leído
5232
Vecesse ha leído el artículo
1751
Total PDF
3481
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219018301811" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.021" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1828" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:562-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731017305628" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.07.020" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1828" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:562-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 54 "formatos" => array:2 [ "HTML" => 35 "PDF" => 19 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Mucormicosis cutánea primaria por <span class="elsevierStyleItalic">Rhizopus arrhizus</span> en una niña de 8 años" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "562" "paginaFinal" => "564" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Primary Cutaneous Mucormycosis Due to <span class="elsevierStyleItalic">Rhizopus arrhizus</span> in an 8-Year-Old Girl" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 888 "Ancho" => 1733 "Tamanyo" => 248336 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Pápulas y seudovesículas eritematosas y purpúricas dispuestas de manera difusa sobre una base eritematosa con un centro necrótico en el abdomen. B. Aspecto grisáceo y putrefacto de la grasa del tejido subcutáneo durante el procedimiento de la biopsia profunda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.F. Albízuri-Prado, A. Sánchez-Orta, A. Rodríguez-Bandera, M. Feito-Rodríguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.F." "apellidos" => "Albízuri-Prado" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez-Orta" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Bandera" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Feito-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018301811" "doi" => "10.1016/j.adengl.2018.05.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301811?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305628?idApp=UINPBA000044" "url" => "/00017310/0000010900000006/v1_201808010427/S0001731017305628/v1_201808010427/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219018301628" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.005" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1826" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:565-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 14 "formatos" => array:2 [ "HTML" => 8 "PDF" => 6 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Response to Secukinumab after Treatment Failure with Ustekinumab in 6 Patients with Plaque Psoriasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "565" "paginaFinal" => "567" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta a secukinumab tras fracaso terapéutico con ustekinumab en seis pacientes con psoriasis en placas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 828 "Ancho" => 2185 "Tamanyo" => 151810 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Response to treatment with secukinumab in patients with an unacceptable response to treatment with ustekinumab.PASI, Psoriasis Area and Severity Index; SEC, secukinumab.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, J. Riera-Monroig, X. Fustà-Novell, M. Alsina Gibert" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Riera-Monroig" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Fustà-Novell" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Alsina Gibert" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305604" "doi" => "10.1016/j.ad.2017.07.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305604?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301628?idApp=UINPBA000044" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301628/v1_201808010420/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018301598" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.002" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1837" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:560-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 2 "PDF" => 1 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Expanding the genetic profile of Hay-Wells syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "560" "paginaFinal" => "562" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ampliando el perfil genético del síndrome de Hay-Wells" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1173 "Ancho" => 900 "Tamanyo" => 121135 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The patient presented congenital wiry, sparse, pale hair on the scalp, eyebrows and eyelids, due to ectodermal dysplasia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Romero-Pérez, B. Encabo-Durán, R. Ramón-Sapena" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Romero-Pérez" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Encabo-Durán" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ramón-Sapena" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305938" "doi" => "10.1016/j.ad.2017.09.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305938?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301598?idApp=UINPBA000044" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301598/v1_201808010420/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Primary Cutaneous Mucormycosis Due to <span class="elsevierStyleItalic">Rhizopus arrhizus</span> in an 8-Year-Old Girl" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "562" "paginaFinal" => "564" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.F. Albízuri-Prado, A. Sánchez-Orta, A. Rodríguez-Bandera, M. Feito-Rodríguez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.F." "apellidos" => "Albízuri-Prado" "email" => array:1 [ 0 => "faprado8@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez-Orta" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Bandera" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Feito-Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital universitario La Paz, Madrid, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mucormicosis cutánea primaria por <span class="elsevierStyleItalic">Rhizopus arrhizus</span> en una niña de 8 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 678 "Ancho" => 900 "Tamanyo" => 230683 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology reveals multiple fungal structures affecting the blood vessels, compatible with mucormycosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 8-year-old girl with a personal history of severe epileptiform encephalopathy was admitted to the pediatric intensive care unit for epileptic status with decreased consciousness, for which treatment with anticonvulsants and systemic corticosteroids was instituted. Two weeks after admission she underwent assessment at the dermatology department for lesions on the abdomen that had appeared a few hours earlier. Erythematous and purpuric papules and pseudovesicles were clustered irregularly on an erythematous base with a necrotic center (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). An underlying firm, infiltrated plaque covered an area greater than that of the visible lesions. Ultrasound showed a poorly defined mass of increased echogenicity in the subcutaneous tissue that was compatible with inflammatory alterations. Given the acute course and the presence of an underlying mass, a deep biopsy was performed, revealing the presence of foul-smelling fatty tissue with a putrefied appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), suggestive of a necrotic infection. A sample was taken for microbiological analysis and calcofluor-white staining and fungal culture were ordered. Direct observation revealed the presence of numerous broad, branched, aseptate hyphae compatible with mucormycosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After extensive early surgical resection liposomal amphotericin B treatment was instituted and corticosteroid treatment gradually withdrawn. Histology revealed intense dermal necrosis and blood vessel obstruction by numerous fungal structures (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Diagnosis was confirmed based on the results of the fungal culture, from which <span class="elsevierStyleItalic">Rhizopus arrhizus</span> was isolated following ethanol-formic acid extraction and MALDI-TOF (matrix-assisted laser desorption/ionization – time-of-flight) mass spectrometry.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> After lesion spread was ruled out the patient was diagnosed with primary cutaneous mucormycosis due to <span class="elsevierStyleItalic">R. arrhizus</span>. The early initiation of treatment resulted in a favorable response and progressive improvement of the patient's clinical picture. No new lesions appeared nor were other organs affected.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Mucormycosis is an opportunistic fungal infection with a rapid, fulminant course caused by fungi of the order Mucorales. The most frequently isolated fungi are those of the genera <span class="elsevierStyleItalic">Rhizopus</span>, <span class="elsevierStyleItalic">Mucor</span>, and <span class="elsevierStyleItalic">Rhizomucor.</span><a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> There is some debate as to whether this group of infections should be described as zygomycosis or mucormycosis, but use of the latter term is supported by the results of molecular studies.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Distinct clinical forms of mucormycosis are described. The most common is rhinocerebral mucormycosis, followed by pulmonary, gastrointestinal, cutaneous, and disseminated forms. The cutaneous form (10%–19% of cases) is the result of direct inoculation of the spores into the dermis or direct contact of the skin with contaminated material.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> It can also be caused by traumatic injuries (70%), surgical interventions (15%), burns (3%), and, in the case of nosocomial infections, contact with contaminated material such as sheets,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> intravenous lines, adhesives,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> or wooden tongue depressors.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Mucormycosis predominantly affects immunocompromised patients. The majority of reported cases have involved patients with blood or metabolic disorders. Our patient was receiving high-dose intravenous corticosteroids for the treatment of an underlying neurological condition.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The typical clinical picture consists of an erythematous, edematous plaque with central ulceration that progresses rapidly and may affect subcutaneous tissue, muscle, and bone.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Atypical clinical presentations include that of our patient, in whom the aforementioned clinical picture was accompanied by eczematous lesions.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6,9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is important to establish diagnosis early. This requires a high level of clinical suspicion, especially in cases with atypical presentations, and the use of early diagnosis techniques such as direct examination of samples treated with KOH or calcofluor-white. A presumptive diagnosis can be established and early treatment initiated based on identification of the characteristic hyphae of Mucorales. The hyphae are wide (5–15<span class="elsevierStyleHsp" style=""></span>μm in diameter), septate, and branched at a 45° angle. Microbiological culture, on which definitive diagnosis is based, can take several days.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In both children and adults, extensive surgical debridement and the administration of systemic antifungals (liposomal amphotericin B, 5–10<span class="elsevierStyleHsp" style=""></span>mg/kg/d) is the treatment of choice. Once stabilized, patients can be treated with oral posaconazole or isavuconazole, either alone or in combination with systemic antifungals.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">11,12</span></a> The duration of treatment has not been clearly established, but usually spans several weeks, until clinical resolution is achieved and the signs and symptoms of infection have disappeared.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The mortality rate associated with primary cutaneous mucormycosis ranges from 4% to 10%, and only 3% of cases progress to disseminated infection, mainly in patients with risk factors (in whom the mortality rate increases to 83%–94%).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The case described here illustrates the importance of the recognition and early diagnosis of cutaneous mucormycosis in order to quickly institute appropriate treatment, which is an important determinant of the clinical course of this infectious disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Albízuri-Prado MF, Sánchez-Orta A, Rodríguez-Bandera A, Feito-Rodríguez M. Mucormicosis cutánea primaria por <span class="elsevierStyleItalic">Rhizopus arrhizus</span> en una niña de 8 años. Actas Dermosifiliogr. 2018;109:562–564.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 888 "Ancho" => 1733 "Tamanyo" => 249150 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, On the patient's abdomen erythematous and purpuric papules and pseudovesicles are arranged diffusely on an erythematous base with a necrotic center. B, Grayish subcutaneous fatty tissue with a putrefied appearance is observed during the deep biopsy procedure.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1052 "Ancho" => 1200 "Tamanyo" => 111289 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Calcofluor-white staining reveals numerous fungal structures consisting of broad, branched, aseptate hyphae compatible with mucormycosis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 678 "Ancho" => 900 "Tamanyo" => 230683 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology reveals multiple fungal structures affecting the blood vessels, compatible with mucormycosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplicación de la espectrometría de masas en micología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Quiles Melero" 1 => "T. Peláez" 2 => "A. Rezusta López" 3 => "J. Garcia-Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0213-005X(16)30187-2" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin." "fecha" => "2016" "volumen" => "34" "paginaInicial" => "26" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27389289" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of mucormycosis in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Petrikkos" 1 => "A. Skiada" 2 => "M. Drogari-Apiranthitou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1469-0691.12563" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect." "fecha" => "2014" "volumen" => "20" "paginaInicial" => "67" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24476100" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Taxonomy of fungi causing mucormycosis and entomophthoramycosis (zygomycosis) and nomenclature of the disease: Molecular mycologic Perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.J. Kwon-Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cir864" "Revista" => array:7 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "2012" "volumen" => "54" "numero" => "Suppl 1" "paginaInicial" => "S8" "paginaFinal" => "S15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22247451" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous mucormycosis: Mycological, clinical, and therapeutic aspects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Bonifaz" 1 => "A. Tirado-Sánchez" 2 => "L. Calderón" 3 => "R.M. Ponce" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Fungal Infect Rep." "fecha" => "2015" "volumen" => "9" "paginaInicial" => "229" "paginaFinal" => "237" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital outbreak of pulmonary and cutaneous zygomycosis due to contaminated linen items from substandard laundry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.C.C. Cheng" 1 => "J.H.K. Chen" 2 => "S.C.Y. Wong" 3 => "S.S.M. Leung" 4 => "S.Y.C. So" 5 => "D.C. Lung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/civ1006" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "2016" "volumen" => "62" "paginaInicial" => "714" "paginaFinal" => "721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26668339" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outbreak of cutaneous zygomycosis associated with the use of adhesive tape in haematology patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Lalayanni" 1 => "P. Baliakas" 2 => "A. Xochelli" 3 => "C. Apostolou" 4 => "M. Arabatzis" 5 => "A. Velegraki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhin.2012.04.007" "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect." "fecha" => "2012" "volumen" => "81" "paginaInicial" => "213" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22633275" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0095" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Rhizopus microsporus</span> in wooden tongue depressors: A major threat or minor inconvenience?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Holzel" 1 => "S. Macqueen" 2 => "A. MacDonald" 3 => "S. Alexander" 4 => "C.K. Campbell" 5 => "E.M. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect." "fecha" => "1998" "volumen" => "38" "paginaInicial" => "113" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9522289" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0100" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous mucormycosis caused by <span class="elsevierStyleItalic">Rhizopus oryzae</span>: A case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Rodríguez-Lobato" 1 => "L. Ramírez-Hobak" 2 => "J.E. Aquino-Matus" 3 => "J.P. Ramírez-Hinojosa" 4 => "V.H. Lozano-Fernández" 5 => "J. Xicohtencatl-Cortes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11046-016-0084-6" "Revista" => array:6 [ "tituloSerie" => "Mycopathologia." "fecha" => "2017" "volumen" => "182" "paginaInicial" => "387" "paginaFinal" => "392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27807669" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0105" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vesicular eruption on the arm of an infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.A. Lumbang" 1 => "B.A. Caufield" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21199639" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0110" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gangrenous cutaneous mucormycosis caused by <span class="elsevierStyleItalic">Rhizopus oryzae</span>: A case report and review of primary cutaneous mucormycosis in China over past 20 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Li" 1 => "S.K. Hwang" 2 => "C. Zhou" 3 => "J. Du" 4 => "J. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11046-013-9654-z" "Revista" => array:6 [ "tituloSerie" => "Mycopathologia." "fecha" => "2013" "volumen" => "176" "paginaInicial" => "123" "paginaFinal" => "128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23615822" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O.A. Cornely" 1 => "S. Arikan-Akdagli" 2 => "E. Dannaoui" 3 => "A.H. Groll" 4 => "K. Lagrou" 5 => "A. Chakrabarti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1469-0691.12539" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect." "fecha" => "2014" "volumen" => "20" "paginaInicial" => "5" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24506442" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0120" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent advances in the management of mucormycosis: From bench to bedside" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Spellberg" 1 => "T.J. Walsh" 2 => "D.P. Kontoyiannis" 3 => "J. Edwards Jr." 4 => "A.S. Ibrahim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/599105" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "2009" "volumen" => "48" "paginaInicial" => "1743" "paginaFinal" => "1751" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19435437" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301811/v1_201808010420/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000006/v1_201808010420/S1578219018301811/v1_201808010420/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301811?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 11 | 22 |
| 2024 Octubre | 81 | 57 | 138 |
| 2024 Septiembre | 72 | 35 | 107 |
| 2024 Agosto | 103 | 58 | 161 |
| 2024 Julio | 90 | 54 | 144 |
| 2024 Junio | 106 | 30 | 136 |
| 2024 Mayo | 104 | 62 | 166 |
| 2024 Abril | 88 | 27 | 115 |
| 2024 Marzo | 78 | 29 | 107 |
| 2024 Febrero | 75 | 28 | 103 |
| 2024 Enero | 73 | 36 | 109 |
| 2023 Diciembre | 79 | 16 | 95 |
| 2023 Noviembre | 69 | 24 | 93 |
| 2023 Octubre | 83 | 38 | 121 |
| 2023 Septiembre | 64 | 36 | 100 |
| 2023 Agosto | 55 | 13 | 68 |
| 2023 Julio | 64 | 27 | 91 |
| 2023 Junio | 71 | 26 | 97 |
| 2023 Mayo | 85 | 20 | 105 |
| 2023 Abril | 64 | 18 | 82 |
| 2023 Marzo | 70 | 25 | 95 |
| 2023 Febrero | 93 | 23 | 116 |
| 2023 Enero | 56 | 25 | 81 |
| 2022 Diciembre | 75 | 46 | 121 |
| 2022 Noviembre | 86 | 33 | 119 |
| 2022 Octubre | 54 | 19 | 73 |
| 2022 Septiembre | 50 | 44 | 94 |
| 2022 Agosto | 38 | 38 | 76 |
| 2022 Julio | 39 | 28 | 67 |
| 2022 Junio | 35 | 26 | 61 |
| 2022 Mayo | 107 | 46 | 153 |
| 2022 Abril | 100 | 22 | 122 |
| 2022 Marzo | 69 | 47 | 116 |
| 2022 Febrero | 56 | 20 | 76 |
| 2022 Enero | 79 | 38 | 117 |
| 2021 Diciembre | 46 | 41 | 87 |
| 2021 Noviembre | 49 | 35 | 84 |
| 2021 Octubre | 62 | 51 | 113 |
| 2021 Septiembre | 50 | 39 | 89 |
| 2021 Agosto | 75 | 27 | 102 |
| 2021 Julio | 78 | 30 | 108 |
| 2021 Junio | 81 | 38 | 119 |
| 2021 Mayo | 52 | 40 | 92 |
| 2021 Abril | 70 | 63 | 133 |
| 2021 Marzo | 60 | 32 | 92 |
| 2021 Febrero | 55 | 38 | 93 |
| 2021 Enero | 44 | 16 | 60 |
| 2020 Diciembre | 34 | 21 | 55 |
| 2020 Noviembre | 40 | 22 | 62 |
| 2020 Octubre | 28 | 17 | 45 |
| 2020 Septiembre | 37 | 12 | 49 |
| 2020 Agosto | 27 | 14 | 41 |
| 2020 Julio | 11 | 22 | 33 |
| 2020 Junio | 26 | 32 | 58 |
| 2020 Mayo | 12 | 18 | 30 |
| 2020 Abril | 10 | 13 | 23 |
| 2020 Marzo | 11 | 4 | 15 |
| 2020 Febrero | 1 | 0 | 1 |
| 2018 Junio | 0 | 1 | 1 |
Mostrar todo
