Scientific Letter
Analysis of the clinical features of infections caused by enterovirus A71 (EV-A71) in Balearic Islands
Análisis de las características clínicas de las infecciones causadas por el enterovirus A71 (EV-A71) en las Islas Baleares
a Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, Spain
b Unidad de Enterovirus, Centro Nacional de Microbiología, Madrid, Spain
c Sección de Urgencias, Servicio de Pediatría, Hospital Universitario Son Espases, Islas Baleares, Spain
Read
5409
Timeswas read the article
2112
Total PDF
3297
Total HTML
Share statistics
array:24 [ "pii" => "S2341287917301618" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.12.006" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2202" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:289-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1580 "formatos" => array:3 [ "EPUB" => 127 "HTML" => 1102 "PDF" => 351 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403317300115" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2016.12.007" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2202" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:289-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3104 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 2367 "PDF" => 592 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Análisis de las características clínicas de las infecciones causadas por el enterovirus A71 (EV-A71) en las Islas Baleares" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "289" "paginaFinal" => "290" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Analysis of the clinical features of infections caused by enterovirus A71 (EV-A71) in Balearic Islands" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jordi Reina, María Cabrerizo, Francesc Ferrés" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Jordi" "apellidos" => "Reina" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Cabrerizo" ] 2 => array:2 [ "nombre" => "Francesc" "apellidos" => "Ferrés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287917301618" "doi" => "10.1016/j.anpede.2016.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917301618?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317300115?idApp=UINPBA00005H" "url" => "/16954033/0000008700000005/v1_201710301212/S1695403317300115/v1_201710301212/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287917301655" "issn" => "23412879" "doi" => "10.1016/j.anpede.2017.01.006" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2209" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:291-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1539 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 954 "PDF" => 466 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Osteoarticular tuberculosis in paediatrics: A review of 20 years of cases in a tertiary hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "291" "paginaFinal" => "292" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tuberculosis osteoarticular en la edad pediátrica, revisión de casos en 20 años en un hospital terciario" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María José Pérez Durán, Bárbara Moreno Sanz-Gadea, Teresa del Rosal Raves, María José Mellado Peña, Fernando Baquero-Artigao" "autores" => array:5 [ 0 => array:2 [ "nombre" => "María José" "apellidos" => "Pérez Durán" ] 1 => array:2 [ "nombre" => "Bárbara" "apellidos" => "Moreno Sanz-Gadea" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "del Rosal Raves" ] 3 => array:2 [ "nombre" => "María José" "apellidos" => "Mellado Peña" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Baquero-Artigao" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403317300334" "doi" => "10.1016/j.anpedi.2017.01.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317300334?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917301655?idApp=UINPBA00005H" "url" => "/23412879/0000008700000005/v1_201710301006/S2341287917301655/v1_201710301006/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287917301588" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.12.005" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "2199" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;87:284-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1378 "formatos" => array:3 [ "EPUB" => 124 "HTML" => 814 "PDF" => 440 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Repeated poisoning episodes: Alarm sign of risk situations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "284" "paginaFinal" => "288" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Episodios repetidos de intoxicación: signo de alarma de situaciones de riesgo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elsa García González, Victoria Trenchs Sainz de la Maza, Lidia Martínez Sánchez, Nuria Ferrer Bosch, Carles Luaces Cubells" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Elsa" "apellidos" => "García González" ] 1 => array:2 [ "nombre" => "Victoria" "apellidos" => "Trenchs Sainz de la Maza" ] 2 => array:2 [ "nombre" => "Lidia" "apellidos" => "Martínez Sánchez" ] 3 => array:2 [ "nombre" => "Nuria" "apellidos" => "Ferrer Bosch" ] 4 => array:2 [ "nombre" => "Carles" "apellidos" => "Luaces Cubells" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403317300085" "doi" => "10.1016/j.anpedi.2016.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317300085?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917301588?idApp=UINPBA00005H" "url" => "/23412879/0000008700000005/v1_201710301006/S2341287917301588/v1_201710301006/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Analysis of the clinical features of infections caused by enterovirus A71 (EV-A71) in Balearic Islands" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "289" "paginaFinal" => "290" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jordi Reina, María Cabrerizo, Francesc Ferrés" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Jordi" "apellidos" => "Reina" "email" => array:1 [ 0 => "jorge.reina@ssib.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Cabrerizo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Francesc" "apellidos" => "Ferrés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Enterovirus, Centro Nacional de Microbiología, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Urgencias, Servicio de Pediatría, Hospital Universitario Son Espases, Islas Baleares, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de las características clínicas de las infecciones causadas por el enterovirus A71 (EV-A71) en las Islas Baleares" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Enteroviruses are a broad group of viruses with a wide geographical distribution. They predominantly affect children with respiratory, gastrointestinal, exanthematous, febrile and neurologic diseases. They are easily transmitted via person-to-person contact through faecal-oral route and have an incubation period of 1–3 days.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Of the more than 100 known enteroviruses, enterovirus 71 (EV-A71) belongs to the <span class="elsevierStyleItalic">Enterovirus A</span> species, which comprehends more than 25 different serotypes, including coxsackievirus A16, which causes hand, foot and mouth disease (HFMD).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Enterovirus 71 was first described in the context of outbreaks of infection with neurologic involvement between 1969 and 1972. Since then, it has been detected all over the world with a varying prevalence.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> It is generally considered to cause mild or moderate respiratory disease, HFMD and neurologic illness of varying severity (meningitis, encephalitis or flaccid paralysis).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> In some cases of HFMD, patients present with encephalitis at the level of the hindbrain, known as rhomboencephalitis, that may cause severe neurologic sequelae.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">After the outbreak of neurologic illness caused by EV-A71 in Catalonia,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> we thought it would be interesting to analyse the clinical characteristics of patients infected by this virus in the Balearic Islands.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We studied the presence of enteroviruses in respiratory samples (from pharyngeal swabs) of paediatric patients with clinical suspicion of acute respiratory tract infection (ARTI) between May 2015 and June 2016.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We performed viral detection by means of a gene amplification technique, a real-time RT-PCR assay capable of detecting and differentiating 16 viruses in one step (Allplex<span class="elsevierStyleSup">®</span> Respiratory Full Panel Assay, Seegene; South Korea). This assay can differentiate between enterovirus and rhinovirus, but cannot be used to serotype enteroviruses. Samples that tested positive for enterovirus were submitted to the Centro Nacional de Microbiología (National Centre of Microbiology, Madrid), where the final serotyping was performed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 5772 respiratory samples were analysed during the period under study, of which 2788 (48.3%) tested positive for a virus. Of the latter, 148 (5.3%) were positive for enterovirus, and 8 strains (5.4%) were serotyped as EV-A71 (amounting to 0.1% of all tested specimens and 0.2% of positive specimens). All cases were sporadic community-acquired infections that did not occur in the context of an outbreak.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of the 8 patients, 4 (50%) were boys and 4 (50%) girls; their median age was 17 months (range, 5 months-3 years). The timeline of the cases was: 1 case (12.5%) in November 2015, and 1 (12.5%) in March, 2 (25%) in May and 4 (50%) in June 2016. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> details the main diseases detected in these patients. Two patients (12.5%) had underlying diseases and 4 (50%) required hospital admission.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">One patient presented with manifestations compatible with aseptic meningitis. The analysis of a cerebrospinal fluid specimen revealed a glucose concentration of 57<span class="elsevierStyleHsp" style=""></span>mg/dL, a protein concentration of 0.34<span class="elsevierStyleHsp" style=""></span>g/L, and counts of 5<span class="elsevierStyleHsp" style=""></span>red blood cells/μL and 40<span class="elsevierStyleHsp" style=""></span> white blood cells/μL (10% neutrophils and 90% lymphocytes). The results of PCR for the detection of neurotropic and respiratory viruses were negative.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Fifty percent of patients had viral co-infection, which involved enterovirus D68 in 3 (75%) and a bocavirus in 1; the percentage of co-infection was of 16.8% for the rest of the detected enteroviruses. All patients had favourable outcomes, and none died due to the viral infection or complications from it.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our study, neurologic involvement was found in only 1 (12.5%) out of all patients with ARTI caused by EV-A71. This patient developed aseptic meningitis, which caused no further complications. The proportion of central nervous system infections in which this virus is involved ranges between 10% and 15%, and increases slightly during outbreaks.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In recent years, several large-scale outbreaks of HFMD have been reported, especially in Asia, associated with central nervous system complications.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The virus has circulated less intensely in Europe, and in Spain there have been reports of outbreaks and sporadic cases of this disease.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the outbreak in Catalonia, there was a predominance of infections with neurologic involvement and in particular with rhomboencephalitis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The sporadic cases detected in our study were associated with less severe disease, as most of them presented as acute respiratory tract infections (ARTIs), with no significant neurologic complications,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> although the small number of cases did not allow reaching any firm conclusions. Some studies seem to suggest that there are different genetic lineages of EV-A71 that may determine its virulence.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Given the sharp emergence of enteroviruses in respiratory and neurologic illnesses in the paediatric population in recent years, it is very important to carry out serotyping and follow-up studies of these infections.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Reina J, Cabrerizo M, Ferrés F. Análisis de las características clínicas de las infecciones causadas por el enterovirus A71 (EV-A71) en las Islas Baleares. An Pediatr (Barc). 2017;87:289–290.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Underlying disease \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Admission \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, cold symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Paracetamol \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">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, pharyngitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amoxicillin \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">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, petechiae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amoxicillin \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">4<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, cold symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Paracetamol \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">5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, cold symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Paracetamol \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">6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, bronchitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Salbutamol, amoxicillin \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">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, cold symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haemophagocytosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Paracetamol, amoxicillin \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">8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, vomiting, ataxia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Salbutamol, ceftriaxone \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aseptic meningitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1576340.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Co-infection with EV-D68.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Co-infection with bocavirus.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Main characteristics of patients with infection by enterovirus A71.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii: E890" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The current status of the disease caused by enterovirus 71 infections: epidemiology, pathogenesis, molecular epidemiology, and vaccine development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.C. Chang" 1 => "S.C. Chen" 2 => "K.T. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/ijerph13090890" "Revista" => array:2 [ "tituloSerie" => "Int J Environ Res Public Health" "fecha" => "2016" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot and mouth disease in Western Australia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. McMinn" 1 => "I. Stratov" 2 => "L. Nagarajan" 3 => "S. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/318454" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2001" "volumen" => "32" "paginaInicial" => "236" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11170913" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outbreak of enterovirus A71 with severe neurological symptoms among children in Catalonia, Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "European Centre for Disease Prevention and Control" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016, June" "editorial" => "ECDC" "editorialLocalizacion" => "Stockholm" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of human enterovirus 71 infections in France, 2000–2009" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Schuffenecker" 1 => "A. Mirand" 2 => "D. Antona" 3 => "C. Henquell" 4 => "J.J. Chomel" 5 => "C. Archimbaud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2010.09.019" "Revista" => array:6 [ "tituloSerie" => "J Clin Virol" "fecha" => "2011" "volumen" => "50" "paginaInicial" => "50" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21035387" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular epidemiology of enterovirus 71, coxsackievirus A16 and A6 associated with hand, foot and mouth disease in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Cabrerizo" 1 => "D. Tarragó" 2 => "C. Muñoz-Almagro" 3 => "E. del Amo" 4 => "M. Domínguez-Gil" 5 => "J.M. Eiros" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "150" "paginaFinal" => "156" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infecciones respiratorias agudas comunitarias causadas por enterovirus en la población pediátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Reina" 1 => "M. Cabrerizo" 2 => "F. Aliaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2016.05.007" "Revista" => array:2 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2016" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008700000005/v1_201710301006/S2341287917301618/v1_201710301006/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008700000005/v1_201710301006/S2341287917301618/v1_201710301006/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917301618?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 11 | 22 |
| 2024 October | 60 | 33 | 93 |
| 2024 September | 57 | 20 | 77 |
| 2024 August | 69 | 56 | 125 |
| 2024 July | 42 | 32 | 74 |
| 2024 June | 45 | 25 | 70 |
| 2024 May | 55 | 36 | 91 |
| 2024 April | 38 | 25 | 63 |
| 2024 March | 29 | 23 | 52 |
| 2024 February | 36 | 31 | 67 |
| 2024 January | 31 | 22 | 53 |
| 2023 December | 26 | 27 | 53 |
| 2023 November | 46 | 21 | 67 |
| 2023 October | 26 | 22 | 48 |
| 2023 September | 16 | 20 | 36 |
| 2023 August | 35 | 20 | 55 |
| 2023 July | 31 | 27 | 58 |
| 2023 June | 43 | 31 | 74 |
| 2023 May | 37 | 15 | 52 |
| 2023 April | 23 | 18 | 41 |
| 2023 March | 53 | 27 | 80 |
| 2023 February | 25 | 9 | 34 |
| 2023 January | 20 | 22 | 42 |
| 2022 December | 40 | 29 | 69 |
| 2022 November | 35 | 36 | 71 |
| 2022 October | 55 | 42 | 97 |
| 2022 September | 41 | 21 | 62 |
| 2022 August | 42 | 56 | 98 |
| 2022 July | 37 | 53 | 90 |
| 2022 June | 41 | 34 | 75 |
| 2022 May | 44 | 38 | 82 |
| 2022 April | 40 | 24 | 64 |
| 2022 March | 48 | 69 | 117 |
| 2022 February | 38 | 32 | 70 |
| 2022 January | 25 | 29 | 54 |
| 2021 December | 34 | 42 | 76 |
| 2021 November | 31 | 53 | 84 |
| 2021 October | 52 | 76 | 128 |
| 2021 September | 19 | 36 | 55 |
| 2021 August | 22 | 41 | 63 |
| 2021 July | 30 | 39 | 69 |
| 2021 June | 38 | 47 | 85 |
| 2021 May | 38 | 33 | 71 |
| 2021 April | 97 | 74 | 171 |
| 2021 March | 49 | 70 | 119 |
| 2021 February | 24 | 17 | 41 |
| 2021 January | 35 | 23 | 58 |
| 2020 December | 34 | 14 | 48 |
| 2020 November | 28 | 23 | 51 |
| 2020 October | 30 | 24 | 54 |
| 2020 September | 36 | 18 | 54 |
| 2020 August | 41 | 8 | 49 |
| 2020 July | 35 | 15 | 50 |
| 2020 June | 34 | 12 | 46 |
| 2020 May | 50 | 20 | 70 |
| 2020 April | 28 | 15 | 43 |
| 2020 March | 50 | 17 | 67 |
| 2020 February | 54 | 20 | 74 |
| 2020 January | 29 | 6 | 35 |
| 2019 December | 53 | 16 | 69 |
| 2019 November | 56 | 8 | 64 |
| 2019 October | 52 | 9 | 61 |
| 2019 September | 39 | 7 | 46 |
| 2019 August | 56 | 27 | 83 |
| 2019 July | 40 | 17 | 57 |
| 2019 June | 68 | 29 | 97 |
| 2019 May | 138 | 17 | 155 |
| 2019 April | 122 | 21 | 143 |
| 2019 March | 46 | 14 | 60 |
| 2019 February | 40 | 27 | 67 |
| 2019 January | 42 | 28 | 70 |
| 2018 December | 38 | 36 | 74 |
| 2018 November | 52 | 27 | 79 |
| 2018 October | 79 | 19 | 98 |
| 2018 September | 27 | 18 | 45 |
| 2018 August | 1 | 0 | 1 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 18 | 0 | 18 |
| 2018 March | 23 | 0 | 23 |
| 2018 February | 8 | 0 | 8 |
| 2018 January | 18 | 0 | 18 |
| 2017 December | 16 | 0 | 16 |
| 2017 October | 0 | 13 | 13 |
Show all
