Erythrovirus B19 infections. Six years of follow-up in adults and children

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Six years of follow-up in adults and children" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "280" "paginaFinal" => "284" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Natàlia Claver Belver, Isabel Sanfeliu Sala, M. Jesús Merino Asensio, Carla Monterde Pedra, Valentí Pineda Solas, Silvia Capilla Rubio, Dionisia Fontanals Aymerich" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Natàlia" "apellidos" => "Claver Belver" "email" => array:1 [ 0 => "nataliaclaver@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Isabel" "apellidos" => "Sanfeliu Sala" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M. 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Seis años de seguimiento en población adulta y pediátrica" ] ] "textoCompleto" => "IntroductionParvovirus B19 was first identified in 1974 by Cossart, and it was associated with disease for the first time in 1981 when it was detected in association with aplastic crises in patients with sickle cell disease.<a class="elsevierStyleCrossRefs" href="#bib0045">1,2</a> Due to its tropism for human erythroid progenitor cells, it was eventually reclassified as Erythrovirus B19 (B19V).<a class="elsevierStyleCrossRef" href="#bib0045">1</a>Erythrovirus B19 is a small DNA virus whose only known host is Homo sapiens. It is mainly transmitted through respiratory secretions or hand-to-mouth contact,<a class="elsevierStyleCrossRef" href="#bib0050">2</a> although vertical transmission from mother to foetus and iatrogenic transmission through blood products are also possible.<a class="elsevierStyleCrossRef" href="#bib0045">1</a> Cases of nosocomial transmission have also been documented. Since it lacks a lipid envelope, it is resistant to physical inactivation with heat or detergents.<a class="elsevierStyleCrossRef" href="#bib0055">3</a>This virus causes fifth disease or erythema infectiosum (EI) of childhood, polyarthralgias/polyarthritis, severe chronic red cell-aplasia in immunocompromised hosts, transient aplastic crises and miscarriage,<a class="elsevierStyleCrossRef" href="#bib0060">4</a> although 20–30% of affected individuals do not develop symptoms.<a class="elsevierStyleCrossRef" href="#bib0065">5</a> It has also been associated with other diseases, such as vasculitis, myocarditis, nephritis, immune thrombocytopenia, haemophagocytic lymphohistiocytosis and acute liver failure, but the causality of B19V in these diseases has not been confirmed.The incubation period of B19V is generally of 1–2 weeks, but may last up to 21 days,<a class="elsevierStyleCrossRef" href="#bib0055">3</a> and the illness follows a biphasic course. It starts with nonspecific flu-like symptoms associated with mild anaemia,<a class="elsevierStyleCrossRef" href="#bib0050">2</a> while the second phase, due to the formation of immune complexes, is characterised by the development of the itchy rash and/or arthralgias,<a class="elsevierStyleCrossRef" href="#bib0045">1</a> possibly accompanied by a second drop in the level of haemoglobin.<a class="elsevierStyleCrossRef" href="#bib0050">2</a>Infected pregnant women may develop a rash or arthralgia, but approximately half remain asymptomatic.<a class="elsevierStyleCrossRef" href="#bib0070">6</a> The rate of vertical transmission is of 17–33%,<a class="elsevierStyleCrossRef" href="#bib0050">2</a> with transmission to the foetus occurring 1–3 weeks after the mother is infected.<a class="elsevierStyleCrossRef" href="#bib0075">7</a> In most foetuses the disease resolves spontaneously, but there are 2 possible complications: hydrops fetalis and/or foetal death.<a class="elsevierStyleCrossRefs" href="#bib0050">2,7</a> The risk of foetal death ranges between 2% and 6%, and is higher when infection occurs in the second trimester of gestation.<a class="elsevierStyleCrossRef" href="#bib0055">3</a> There are no known cases of associated congenital anomalies.<a class="elsevierStyleCrossRef" href="#bib0070">6</a>Erythrovirus B19 is found worldwide and can cause sporadic infection or epidemic outbreaks, with a cyclical pattern of epidemic outbreaks occurring every 2–5 years.<a class="elsevierStyleCrossRefs" href="#bib0045">1,4</a> In 70% of cases, primary infection occurs during childhood or adolescence,<a class="elsevierStyleCrossRef" href="#bib0045">1</a> and the prevalence of IgG antibodies against the virus in adults ranges from 40% to 60%, reaching 90% in the elderly.<a class="elsevierStyleCrossRef" href="#bib0060">4</a>In 2015 we detected an increase in the detection of IgM antibodies against B19V, which led us to review the infections diagnosed in our hospital since serologic testing for B19V was first introduced in 2010 with the aim of determining the incidence in our catchment population. We also found that while B19V is broadly associated with childhood, there were many cases in adults, so we decided to review the clinical features in the adult and paediatric populations and the differences between them.Materials and methodsWe reviewed data on the serologic tests for detection of B19V performed in our laboratory in the 2010–2015 period, and selected the cases with a diagnosis of acute infection by Erythrovirus B19. The presence of antigen-specific IgM is indicative or acute infection or recent exposure, as these antibodies appear 10–12 days after exposure and persists for 3–6 months.<a class="elsevierStyleCrossRef" href="#bib0050">2</a> Specific IgG appears a few days following detection of IgM and persists for years at very low concentrations, indicating previous infection or immunity.<a class="elsevierStyleCrossRef" href="#bib0055">3</a> We interpreted serologic results following the guidelines cited in the reference section: a positive IgM result with a negative IgG result is suggestive of acute infection and should be followed up with another test 1–2 weeks later to verify IgG seroconversion; positive results for both IgM and IgG suggest an acute or recent infection; a negative IgM result with a positive IgG result are indicative of past infection and immunity; and negative results for both IgM and IgG of a lack of exposure to or infection by the virus.<a class="elsevierStyleCrossRef" href="#bib0050">2</a>Serologic tests were performed using the EVOLIS™ system (Bio-Rad Laboratories, Hercules, California, United States) and the LIAISON® Biotrin Parvovirus B19 IgG/IgM panel (DiaSorin, Dublin, Ireland) for detection of anti-Erythrovirus B19 IgG and IgM, with a positive result defined as an index greater than 1.1.We conducted a retrospective study of the patients with a diagnosis of Erythrovirus B19 infection to establish the demographic, clinical and laboratory (haemoglobin levels, platelet count, white blood cell [WBC] count and serum level of C-reactive protein [CRP]) characteristics of this disease.ResultsIn the 2010–2015 period, there were a total of 998 orders for antibody tests for Erythrovirus B19 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The mean number of orders per year was 166, with a slight and statistically significant increase over time, from 151 in 2010 to 208 in 2015 (P<.01).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>During this period, there were 56 diagnosed cases of acute infection Erythrovirus B19 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). We did not find significant differences in the distribution by sex in paediatric patients (P=.272), but there was a significant difference in incidence between the sexes in adults (P=.006).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The incidence in this period was of 9.3cases/year, peaking in years 2012 and 2015, with 15 and 23 cases, respectively. Seventy-seven percent of cases occurred in spring or summer, with the annual incidence peaking between May and July, when 54% of the total cases clustered.<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the distribution of symptoms and laboratory findings.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>We did not find any differences in presentation based on sex, but there were differences based on age, as fever and rash were more frequent in paediatric patients while arthralgia was the characteristic feature in adult patients.Anaemia was frequent in both subsets of patients. We ought to note that of the 22 cases presenting with anaemia, the latter was mild to moderate in 22 cases, although it was severe in 4 with haemoglobin levels of less than 60g/L. These cases occurred in patients with underlying blood disorders: 2 children (homozygous sickle cell anaemia; history of haemolytic anaemia) and 2 adults (autoimmune haemolytic anaemia; systemic lupus erythematosus with chronic iron deficiency anaemia). Abnormal WBC counts were common in both groups, usually with an increased count. Thrombocytopenia was less frequent and usually mild, although it occurred in 23% of the paediatric patients, with platelet counts of less than 85±28.6×106/L.Of all paediatric patients, only 2 had a relevant medical history (the 2 patients with blood disorders). <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarises the data for the 28 cases in adult patients (excluding pregnant women) based on the presence (n=9) or absence (n=19) of pre-existing diseases. Two women in this group sought care due to contact with a direct relative exhibiting symptoms of infection by Erythrovirus B19. We did not find statistically significant differences in the presenting symptoms based on the medical history or presence of underlying disease except between patients with blood disorders, of who 100% presented with severe anaemia and 50% with fever, and patients with non-haematologic disorders, who presented with other signs and symptoms of B19V infection. All patients received symptomatic treatment with antipyretics and/or analgesics, except for patients with severe anaemia, who received transfusions of red blood cell concentrates. All had favourable outcomes.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The other 6 cases detected in adults occurred in pregnant women. In 2 of them, testing was performed on account of their close contact with a child with infection by B19V, and in 1 as part of a workup following miscarriage, while the reason for ordering testing in the remaining 3 is unknown. In one case, the foetus had a completely normal development. In 3 cases, the foetus experienced abnormalities during gestation (polyhydramnios, oligoamnios and intrauterine growth restriction) without complications and with favourable outcomes after birth, but we could not establish whether these abnormalities were associated to the maternal infection by B19V. In the other 2 cases, the foetuses suffered severe complications of infection. In the first one, the mother sought care due to contact with her own child that had B19V infection, and the ultrasound scan at 26 weeks’ gestation revealed a massive foetal haemorrhage that required termination of the pregnancy. In the other case, the mother had a miscarriage due to foetal death at 11 weeks’ gestation, and the subsequent investigation revealed the presence of B19V-specific IgM antibodies. This was the only pregnant women in our series that experienced symptoms, a mild itchy rash in the lower extremities, 3 weeks before the miscarriage.DiscussionWe found an incidence of infection by Erythrovirus B19 in our catchment population of 9.3cases/year. It is important to consider that 30% of infected individuals do not develop symptoms and that most that do have mild manifestations do not require medical attention or present with features (infectious rash) compatible with Erythrovirus B19 and thus do not require confirmation by serologic testing. For the above reasons, the actual incidence in the population is underestimated in our case series.We did not find a different incidence in male versus female patients in the paediatric population, but we did find a significant difference based on sex in adult patients, with 82% of the cases diagnosed in women and a proportion of positive assay results of 7% in women 7% (38/540) compared to 1.2% in men (2/160). We hypothesis that the higher incidence in women could be explained by the higher frequency of arthralgia, especially of long duration, in women,<a class="elsevierStyleCrossRef" href="#bib0055">3</a> which leads these patients to seek medical care, and by the more frequent contact with children, which may facilitate transmission of the virus.As described in previous studies, we found that rash and fever were more common presentations in paediatric patients, while the most common presentation in adult patients was arthralgia, often associated with fever and/or rash. Anaemia was a frequent finding (46%) in both children and adults, but it was usually mild, with haemoglobin levels greater than 90g/L. However, in patients with underlying blood disorders the anaemia could be severe, triggering aplastic crises and requiring transfusions. Another frequent finding in both age groups was elevation of serum CRP levels and abnormal WBC counts with a tendency towards leucocytosis. We did not find any other significant differences in presentation based on the previous medical history.We ought to emphasise the risk to the foetus during pregnancy. The incidence of infection by B19V in pregnant women is less than 4%,<a class="elsevierStyleCrossRef" href="#bib0050">2</a> and most remain asymptomatic. The rate of vertical transmission is of less than 35%,<a class="elsevierStyleCrossRef" href="#bib0075">7</a> but even though foetal infection can resolve spontaneously, there is also a risk of severe infection that may even be life-threatening, especially if it occurs before 20 weeks’ gestation. According to the American College of Obstetricians and Gynecologists (ACOG), once B19V infection is diagnosed, ultrasound scans should be performed weekly or every 15 days for 10–12 weeks to prevent hydrops fetalis. After 12 weeks, the risk of developing hydrops fetalis is nearly nonexistent.<a class="elsevierStyleCrossRef" href="#bib0080">8</a>Serologic testing for Erythrovirus B19 (IgG and IgM) allows the diagnosis of acute infection. It is also possible to perform viral DNA testing in serum samples, but this method is more complex and expensive and offers no advantages over antibody assays except in cases of aplastic crisis and immunocompromised patients.<a class="elsevierStyleCrossRef" href="#bib0055">3</a>The performance of antibody assays for Erythrovirus B19 in our laboratory allowed us to establish the characteristics of this infection in our region and identify specific clinical presentations of the associated illness that could otherwise not be given a correct aetiological diagnosis. We found while a total of 998 immunoassays were performed in our hospital, only 56 patients (5.6%) received a diagnosis of acute infection by B19V. However, it is important to take into account infection by B19V in cases of joint problems of recent onset and unknown aetiology, aplastic crisis in immunocompetent patients, red cell aplasia in immunocompromised patients and in pregnant women, as the identification of this aetiology is relevant in clinical decision making and can result in improved management of the patient.In conclusion, while infection by Erythrovirus B19 can be a self-limiting disease with a mild course, especially in children, it can lead to severe complications requiring regular monitoring and/or treatment, especially in pregnant women, immunocompromised individuals or patients with underlying blood disorders.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1185912" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1105629" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1185913" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1105630" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-18" "fechaAceptado" => "2018-05-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1105629" "palabras" => array:4 [ 0 => "Parvovirus" 1 => "B19" 2 => "Erythrovirus" 3 => "Epidemiology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1105630" "palabras" => array:4 [ 0 => "Parvovirus" 1 => "B19" 2 => "Erythrovirus" 3 => "Epidemiología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe aetiological agent of erythema infectiosum is Erythrovirus B19 (also known as parvovirus B19), frequently found in children and adolescents, but also associated with arthropathy, aplastic crisis, and abortion in adults. Material and methodsA retrospective study of Erythrovirus B19 cases in the years 2010–2015. ResultsOf the 56 cases of Erythrovirus B19 diagnosed, 34 were adults (32 women and 2 men) and 22 younger than 18 years (12 girls and 10 boys). Six cases were in pregnant women. Infections mainly occurred between spring and summer. In childhood, fever (64%), rash (50%), and anaemia (55%) were the most frequent symptoms. However, arthralgia (59%) was the most frequent symptom in adults, and less frequent were anaemia (41%), fever (32%), and rash (29%). ConclusionsThe characteristic clinical presentation in childhood was rash and fever, whereas in adults it was arthralgia. Anaemia is also frequent, but only severe in previous haematological disease. It should be pointed out that Erythrovirus B19 infection during pregnancy could severely affect the foetus." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl Erythrovirus B19 (anteriormente denominado parvovirus B19) es el agente etiológico del eritema infeccioso que afecta mayoritariamente durante la infancia y la adolescencia, pero también está relacionado con artropatías, crisis aplásicas y abortos en adultos. El propósito de esta revisión es estudiar las características de las infecciones causadas por Erythrovirus B19 diagnosticadas en nuestro hospital en los últimos 6 años y las diferencias entre la población adulta y la pediátrica. Material y métodosEstudio retrospectivo de los casos diagnosticados de Erythrovirus B19 mediante serología, entre enero de 2010 y diciembre de 2015. ResultadosFueron diagnosticados 56 casos, 34 adultos (32 mujeres y 2 varones) y 22 menores de 18 años (12 niñas y 10 niños). El 75% de los casos se dieron entre primavera y verano. Seis fueron en gestantes y en 2 hubo complicaciones graves que conllevaron la muerte fetal. En la población pediátrica los síntomas más frecuentes fueron fiebre (64%), exantema (50%) y anemia (55%). En adultos las artralgias (59%) y menos frecuentemente la anemia (41%), la fiebre (32%) y el exantema (29%). ConclusionesEn pediatría la clínica más frecuente es el exantema y la fiebre, y en adultos las artralgias. También es frecuente la anemia, los casos más graves en presencia de enfermedad hematológica previa. Hay que destacar la grave afectación que pueden sufrir los fetos en las gestantes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Claver Belver N, Sanfeliu Sala I, Merino Asensio MJ, Monterde Pedra C, Pineda Solas V, Capilla Rubio S, et al. Infecciones por Erythrovirus B19. Seis años de seguimiento en población adulta y pediátrica. An Pediatr (Barc). 2019;90:280–284." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Previous presentations: This study was presented as a poster at the XXIV Jornadas de la Societat Catalana de Malalties Infeccioses i Microbiologia Clínica, October 23–24, 2015, St. Hilari Sacalm, Spain; and at the XX National Congress of the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, May 26–28, 2016, Barcelona, Spain." ] ] "multimedia" => array:4 [ 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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Children (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Adults (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Tests performed Sex</td><td class="td" title="table-entry " align="left" valign="top">998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">298 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">700 (70) \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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">311 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">151 (51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">160 (23) \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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">687 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147 (49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">540 (77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">IgG-positive Sex</td><td class="td" title="table-entry " align="left" valign="top">597 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">467 (67) \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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">180 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68 (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">112 (24) \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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">417 (70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">355 (76) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">IgM-positive<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> Sex</td><td class="td" title="table-entry " align="left" valign="top">65 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 (6) \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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">12 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (5) \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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 (82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (95) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2022424.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "The 65 assays positive for IgM corresponded to 56 patients; 2 serologic tests were performed in 9 patients (3 children and 6 adults)." ] ] ] "descripcion" => array:1 [ "en" => "Serologic tests performed between 2010 and 2015." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Total n=56 \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">Children n=22 (39%) \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">Adults n=34 (61%) \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">Mean age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 years (0.5–12 years)<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 years (25–63 years)<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">12 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (6) \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">Female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 (79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (94) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgM-positive (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (100) \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">IgG-positive (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (97) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2022425.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Age range of patients." ] ] ] "descripcion" => array:1 [ "en" => "Age, sex and serologic findings in the 56 patients with acute infection by Erythrovirus B19." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Total n=56 (%) \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">Children n=22 (%) \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">Adults n=34 (%) \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">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (32) \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">Rash \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (29) \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">Gastrointestinal symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6) \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">Arthralgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (59) \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">Lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (41) \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">Mild (91–120g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (79) \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">Moderate (60–90g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (7) \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">Severe (<60g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Elevated CRP (>0.5mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal WBC count \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (18) \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">Leukopenia (<4000×106cells/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (17) \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">Leucocytosis<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thrombocytopenia (<130000×106cells/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2022427.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Leucocytosis: WBC >17000×106/L in patients aged <6 years; >14000×106/L in patients aged 6–16 years and >11000×106/L in patients aged >16 years." ] ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory characteristics of the patients." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Documented non-haematologic disorders: Crohn disease; hypothyroidism and rheumatoid arthritis; atopic dermatitis; uterine fibroids; dyslipidaemia; nonspecific rheumatism and fibrositis; hypertension and diabetes mellitus.Documented blood disorders: autoimmune haemolytic anaemia and systemic lupus erythematosus associated with chronic iron deficiency anaemia." "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="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">No relevant history n=19 (%) \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">Relevant history</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Non-haematologic disorders n=7 (%) \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">Blood disorders n=2 (%) \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">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (50) \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">Rash \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \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">Gastrointestinal symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \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">Arthralgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \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">Lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100) \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">Mild (91–120g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \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">Moderate (60–90g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \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">Severe (<60g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Elevated CRP (>0.5mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; 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Documento Control Calidad SEIMC" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. García-Tapia" 1 => "M.C. Lozano Domínguez" 2 => "C. Fernández Gutiérrez del Álamo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2005" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="https://www.aepap.org/sites/default/files/documento/archivos-adjuntos/parvovirus_2_1.pdf">https://www.aepap.org/sites/default/files/documento/archivos-adjuntos/parvovirus_2_1.pdf</a> [accessed 15.07.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por Parvovirus B19 y Embarazo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. 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Original Article

Erythrovirus B19 infections. Six years of follow-up in adults and children

Infecciones por Erythrovirus B19. Seis años de seguimiento en población adulta y pediátrica

Natàlia Claver Belvera,

Corresponding author

nataliaclaver@gmail.com

Corresponding author.

, Isabel Sanfeliu Salaa, M. Jesús Merino Asensioa, Carla Monterde Pedrab, Valentí Pineda Solasb, Silvia Capilla Rubioa, Dionisia Fontanals Aymericha

a Laboratorio de Microbiología, Corporació Sanitària, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain

b Servicio de Pediatría, Corporació Sanitària, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain

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        "titulo" => "Infecciones por <span class="elsevierStyleItalic">Erythrovirus</span> B19&#46; Seis a&#241;os de seguimiento en poblaci&#243;n adulta y pedi&#225;trica"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Parvovirus B19</span> was first identified in 1974 by Cossart&#44; and it was associated with disease for the first time in 1981 when it was detected in association with aplastic crises in patients with sickle cell disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> Due to its tropism for human erythroid progenitor cells&#44; it was eventually reclassified as <span class="elsevierStyleItalic">Erythrovirus B19</span> &#40;B19V&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Erythrovirus B19</span> is a small DNA virus whose only known host is <span class="elsevierStyleItalic">Homo sapiens</span>&#46; It is mainly transmitted through respiratory secretions or hand-to-mouth contact&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> although vertical transmission from mother to foetus and iatrogenic transmission through blood products are also possible&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Cases of nosocomial transmission have also been documented&#46; Since it lacks a lipid envelope&#44; it is resistant to physical inactivation with heat or detergents&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This virus causes fifth disease or erythema infectiosum &#40;EI&#41; of childhood&#44; polyarthralgias&#47;polyarthritis&#44; severe chronic red cell-aplasia in immunocompromised hosts&#44; transient aplastic crises and miscarriage&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> although 20&#8211;30&#37; of affected individuals do not develop symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> It has also been associated with other diseases&#44; such as vasculitis&#44; myocarditis&#44; nephritis&#44; immune thrombocytopenia&#44; haemophagocytic lymphohistiocytosis and acute liver failure&#44; but the causality of B19V in these diseases has not been confirmed&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The incubation period of B19V is generally of 1&#8211;2 weeks&#44; but may last up to 21 days&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and the illness follows a biphasic course&#46; It starts with nonspecific flu-like symptoms associated with mild anaemia&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> while the second phase&#44; due to the formation of immune complexes&#44; is characterised by the development of the itchy rash and&#47;or arthralgias&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> possibly accompanied by a second drop in the level of haemoglobin&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Infected pregnant women may develop a rash or arthralgia&#44; but approximately half remain asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> The rate of vertical transmission is of 17&#8211;33&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> with transmission to the foetus occurring 1&#8211;3 weeks after the mother is infected&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> In most foetuses the disease resolves spontaneously&#44; but there are 2 possible complications&#58; hydrops fetalis and&#47;or foetal death&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;7</span></a> The risk of foetal death ranges between 2&#37; and 6&#37;&#44; and is higher when infection occurs in the second trimester of gestation&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> There are no known cases of associated congenital anomalies&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Erythrovirus B19</span> is found worldwide and can cause sporadic infection or epidemic outbreaks&#44; with a cyclical pattern of epidemic outbreaks occurring every 2&#8211;5 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;4</span></a> In 70&#37; of cases&#44; primary infection occurs during childhood or adolescence&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and the prevalence of IgG antibodies against the virus in adults ranges from 40&#37; to 60&#37;&#44; reaching 90&#37; in the elderly&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2015 we detected an increase in the detection of IgM antibodies against B19V&#44; which led us to review the infections diagnosed in our hospital since serologic testing for B19V was first introduced in 2010 with the aim of determining the incidence in our catchment population&#46; We also found that while B19V is broadly associated with childhood&#44; there were many cases in adults&#44; so we decided to review the clinical features in the adult and paediatric populations and the differences between them&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">We reviewed data on the serologic tests for detection of B19V performed in our laboratory in the 2010&#8211;2015 period&#44; and selected the cases with a diagnosis of acute infection by <span class="elsevierStyleItalic">Erythrovirus B19</span>&#46; The presence of antigen-specific IgM is indicative or acute infection or recent exposure&#44; as these antibodies appear 10&#8211;12 days after exposure and persists for 3&#8211;6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Specific IgG appears a few days following detection of IgM and persists for years at very low concentrations&#44; indicating previous infection or immunity&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> We interpreted serologic results following the guidelines cited in the reference section&#58; a positive IgM result with a negative IgG result is suggestive of acute infection and should be followed up with another test 1&#8211;2 weeks later to verify IgG seroconversion&#59; positive results for both IgM and IgG suggest an acute or recent infection&#59; a negative IgM result with a positive IgG result are indicative of past infection and immunity&#59; and negative results for both IgM and IgG of a lack of exposure to or infection by the virus&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Serologic tests were performed using the EVOLIS&#8482; system &#40;Bio-Rad Laboratories&#44; Hercules&#44; California&#44; United States&#41; and the LIAISON<span class="elsevierStyleSup">&#174;</span> Biotrin Parvovirus B19 IgG&#47;IgM panel &#40;DiaSorin&#44; Dublin&#44; Ireland&#41; for detection of anti-<span class="elsevierStyleItalic">Erythrovirus B19</span> IgG and IgM&#44; with a positive result defined as an index greater than 1&#46;1&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We conducted a retrospective study of the patients with a diagnosis of <span class="elsevierStyleItalic">Erythrovirus B19</span> infection to establish the demographic&#44; clinical and laboratory &#40;haemoglobin levels&#44; platelet count&#44; white blood cell &#91;WBC&#93; count and serum level of C-reactive protein &#91;CRP&#93;&#41; characteristics of this disease&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">In the 2010&#8211;2015 period&#44; there were a total of 998 orders for antibody tests for <span class="elsevierStyleItalic">Erythrovirus</span> B19 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The mean number of orders per year was 166&#44; with a slight and statistically significant increase over time&#44; from 151 in 2010 to 208 in 2015 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">During this period&#44; there were 56 diagnosed cases of acute infection <span class="elsevierStyleItalic">Erythrovirus B19</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; We did not find significant differences in the distribution by sex in paediatric patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;272&#41;&#44; but there was a significant difference in incidence between the sexes in adults &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The incidence in this period was of 9&#46;3<span class="elsevierStyleHsp" style=""></span>cases&#47;year&#44; peaking in years 2012 and 2015&#44; with 15 and 23 cases&#44; respectively&#46; Seventy-seven percent of cases occurred in spring or summer&#44; with the annual incidence peaking between May and July&#44; when 54&#37; of the total cases clustered&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the distribution of symptoms and laboratory findings&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We did not find any differences in presentation based on sex&#44; but there were differences based on age&#44; as fever and rash were more frequent in paediatric patients while arthralgia was the characteristic feature in adult patients&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Anaemia was frequent in both subsets of patients&#46; We ought to note that of the 22 cases presenting with anaemia&#44; the latter was mild to moderate in 22 cases&#44; although it was severe in 4 with haemoglobin levels of less than 60<span class="elsevierStyleHsp" style=""></span>g&#47;L&#46; These cases occurred in patients with underlying blood disorders&#58; 2 children &#40;homozygous sickle cell anaemia&#59; history of haemolytic anaemia&#41; and 2 adults &#40;autoimmune haemolytic anaemia&#59; systemic lupus erythematosus with chronic iron deficiency anaemia&#41;&#46; Abnormal WBC counts were common in both groups&#44; usually with an increased count&#46; Thrombocytopenia was less frequent and usually mild&#44; although it occurred in 23&#37; of the paediatric patients&#44; with platelet counts of less than 85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;L&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Of all paediatric patients&#44; only 2 had a relevant medical history &#40;the 2 patients with blood disorders&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarises the data for the 28 cases in adult patients &#40;excluding pregnant women&#41; based on the presence &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; or absence &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41; of pre-existing diseases&#46; Two women in this group sought care due to contact with a direct relative exhibiting symptoms of infection by <span class="elsevierStyleItalic">Erythrovirus B19</span>&#46; We did not find statistically significant differences in the presenting symptoms based on the medical history or presence of underlying disease except between patients with blood disorders&#44; of who 100&#37; presented with severe anaemia and 50&#37; with fever&#44; and patients with non-haematologic disorders&#44; who presented with other signs and symptoms of B19V infection&#46; All patients received symptomatic treatment with antipyretics and&#47;or analgesics&#44; except for patients with severe anaemia&#44; who received transfusions of red blood cell concentrates&#46; All had favourable outcomes&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The other 6 cases detected in adults occurred in pregnant women&#46; In 2 of them&#44; testing was performed on account of their close contact with a child with infection by B19V&#44; and in 1 as part of a workup following miscarriage&#44; while the reason for ordering testing in the remaining 3 is unknown&#46; In one case&#44; the foetus had a completely normal development&#46; In 3 cases&#44; the foetus experienced abnormalities during gestation &#40;polyhydramnios&#44; oligoamnios and intrauterine growth restriction&#41; without complications and with favourable outcomes after birth&#44; but we could not establish whether these abnormalities were associated to the maternal infection by B19V&#46; In the other 2 cases&#44; the foetuses suffered severe complications of infection&#46; In the first one&#44; the mother sought care due to contact with her own child that had B19V infection&#44; and the ultrasound scan at 26 weeks&#8217; gestation revealed a massive foetal haemorrhage that required termination of the pregnancy&#46; In the other case&#44; the mother had a miscarriage due to foetal death at 11 weeks&#8217; gestation&#44; and the subsequent investigation revealed the presence of B19V-specific IgM antibodies&#46; This was the only pregnant women in our series that experienced symptoms&#44; a mild itchy rash in the lower extremities&#44; 3 weeks before the miscarriage&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">We found an incidence of infection by <span class="elsevierStyleItalic">Erythrovirus B19</span> in our catchment population of 9&#46;3<span class="elsevierStyleHsp" style=""></span>cases&#47;year&#46; It is important to consider that 30&#37; of infected individuals do not develop symptoms and that most that do have mild manifestations do not require medical attention or present with features &#40;infectious rash&#41; compatible with <span class="elsevierStyleItalic">Erythrovirus B19</span> and thus do not require confirmation by serologic testing&#46; For the above reasons&#44; the actual incidence in the population is underestimated in our case series&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">We did not find a different incidence in male versus female patients in the paediatric population&#44; but we did find a significant difference based on sex in adult patients&#44; with 82&#37; of the cases diagnosed in women and a proportion of positive assay results of 7&#37; in women 7&#37; &#40;38&#47;540&#41; compared to 1&#46;2&#37; in men &#40;2&#47;160&#41;&#46; We hypothesis that the higher incidence in women could be explained by the higher frequency of arthralgia&#44; especially of long duration&#44; in women&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> which leads these patients to seek medical care&#44; and by the more frequent contact with children&#44; which may facilitate transmission of the virus&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As described in previous studies&#44; we found that rash and fever were more common presentations in paediatric patients&#44; while the most common presentation in adult patients was arthralgia&#44; often associated with fever and&#47;or rash&#46; Anaemia was a frequent finding &#40;46&#37;&#41; in both children and adults&#44; but it was usually mild&#44; with haemoglobin levels greater than 90<span class="elsevierStyleHsp" style=""></span>g&#47;L&#46; However&#44; in patients with underlying blood disorders the anaemia could be severe&#44; triggering aplastic crises and requiring transfusions&#46; Another frequent finding in both age groups was elevation of serum CRP levels and abnormal WBC counts with a tendency towards leucocytosis&#46; We did not find any other significant differences in presentation based on the previous medical history&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">We ought to emphasise the risk to the foetus during pregnancy&#46; The incidence of infection by B19V in pregnant women is less than 4&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> and most remain asymptomatic&#46; The rate of vertical transmission is of less than 35&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> but even though foetal infection can resolve spontaneously&#44; there is also a risk of severe infection that may even be life-threatening&#44; especially if it occurs before 20 weeks&#8217; gestation&#46; According to the American College of Obstetricians and Gynecologists &#40;ACOG&#41;&#44; once B19V infection is diagnosed&#44; ultrasound scans should be performed weekly or every 15 days for 10&#8211;12 weeks to prevent hydrops fetalis&#46; After 12 weeks&#44; the risk of developing hydrops fetalis is nearly nonexistent&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Serologic testing for <span class="elsevierStyleItalic">Erythrovirus B19</span> &#40;IgG and IgM&#41; allows the diagnosis of acute infection&#46; It is also possible to perform viral DNA testing in serum samples&#44; but this method is more complex and expensive and offers no advantages over antibody assays except in cases of aplastic crisis and immunocompromised patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The performance of antibody assays for <span class="elsevierStyleItalic">Erythrovirus B19</span> in our laboratory allowed us to establish the characteristics of this infection in our region and identify specific clinical presentations of the associated illness that could otherwise not be given a correct aetiological diagnosis&#46; We found while a total of 998 immunoassays were performed in our hospital&#44; only 56 patients &#40;5&#46;6&#37;&#41; received a diagnosis of acute infection by B19V&#46; However&#44; it is important to take into account infection by B19V in cases of joint problems of recent onset and unknown aetiology&#44; aplastic crisis in immunocompetent patients&#44; red cell aplasia in immunocompromised patients and in pregnant women&#44; as the identification of this aetiology is relevant in clinical decision making and can result in improved management of the patient&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion&#44; while infection by <span class="elsevierStyleItalic">Erythrovirus B19</span> can be a self-limiting disease with a mild course&#44; especially in children&#44; it can lead to severe complications requiring regular monitoring and&#47;or treatment&#44; especially in pregnant women&#44; immunocompromised individuals or patients with underlying blood disorders&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aetiological agent of <span class="elsevierStyleItalic">erythema infectiosum</span> is <span class="elsevierStyleItalic">Erythrovirus</span> B19 &#40;also known as parvovirus B19&#41;&#44; frequently found in children and adolescents&#44; but also associated with arthropathy&#44; aplastic crisis&#44; and abortion in adults&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study of <span class="elsevierStyleItalic">Erythrovirus</span> B19 cases in the years 2010&#8211;2015&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 56 cases of <span class="elsevierStyleItalic">Erythrovirus</span> B19 diagnosed&#44; 34 were adults &#40;32 women and 2 men&#41; and 22 younger than 18 years &#40;12 girls and 10 boys&#41;&#46; Six cases were in pregnant women&#46; Infections mainly occurred between spring and summer&#46; In childhood&#44; fever &#40;64&#37;&#41;&#44; rash &#40;50&#37;&#41;&#44; and anaemia &#40;55&#37;&#41; were the most frequent symptoms&#46; However&#44; arthralgia &#40;59&#37;&#41; was the most frequent symptom in adults&#44; and less frequent were anaemia &#40;41&#37;&#41;&#44; fever &#40;32&#37;&#41;&#44; and rash &#40;29&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The characteristic clinical presentation in childhood was rash and fever&#44; whereas in adults it was arthralgia&#46; Anaemia is also frequent&#44; but only severe in previous haematological disease&#46; It should be pointed out that <span class="elsevierStyleItalic">Erythrovirus</span> B19 infection during pregnancy could severely affect the foetus&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El <span class="elsevierStyleItalic">Erythrovirus</span> B19 &#40;anteriormente denominado parvovirus B19&#41; es el agente etiol&#243;gico del eritema infeccioso que afecta mayoritariamente durante la infancia y la adolescencia&#44; pero tambi&#233;n est&#225; relacionado con artropat&#237;as&#44; crisis apl&#225;sicas y abortos en adultos&#46; El prop&#243;sito de esta revisi&#243;n es estudiar las caracter&#237;sticas de las infecciones causadas por <span class="elsevierStyleItalic">Erythrovirus</span> B19 diagnosticadas en nuestro hospital en los &#250;ltimos 6 a&#241;os y las diferencias entre la poblaci&#243;n adulta y la pedi&#225;trica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de los casos diagnosticados de <span class="elsevierStyleItalic">Erythrovirus</span> B19 mediante serolog&#237;a&#44; entre enero de 2010 y diciembre de 2015&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fueron diagnosticados 56 casos&#44; 34 adultos &#40;32 mujeres y 2 varones&#41; y 22 menores de 18 a&#241;os &#40;12 ni&#241;as y 10 ni&#241;os&#41;&#46; El 75&#37; de los casos se dieron entre primavera y verano&#46; Seis fueron en gestantes y en 2 hubo complicaciones graves que conllevaron la muerte fetal&#46; En la poblaci&#243;n pedi&#225;trica los s&#237;ntomas m&#225;s frecuentes fueron fiebre &#40;64&#37;&#41;&#44; exantema &#40;50&#37;&#41; y anemia &#40;55&#37;&#41;&#46; En adultos las artralgias &#40;59&#37;&#41; y menos frecuentemente la anemia &#40;41&#37;&#41;&#44; la fiebre &#40;32&#37;&#41; y el exantema &#40;29&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En pediatr&#237;a la cl&#237;nica m&#225;s frecuente es el exantema y la fiebre&#44; y en adultos las artralgias&#46; Tambi&#233;n es frecuente la anemia&#44; los casos m&#225;s graves en presencia de enfermedad hematol&#243;gica previa&#46; Hay que destacar la grave afectaci&#243;n que pueden sufrir los fetos en las gestantes&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Claver Belver N&#44; Sanfeliu Sala I&#44; Merino Asensio MJ&#44; Monterde Pedra C&#44; Pineda Solas V&#44; Capilla Rubio S&#44; et al&#46; Infecciones por <span class="elsevierStyleItalic">Erythrovirus</span> B19&#46; Seis a&#241;os de seguimiento en poblaci&#243;n adulta y pedi&#225;trica&#46; An Pediatr &#40;Barc&#41;&#46; 2019&#59;90&#58;280&#8211;284&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025"><span class="elsevierStyleBold">Previous presentations&#58;</span> This study was presented as a poster at the XXIV Jornadas de la Societat Catalana de Malalties Infeccioses i Microbiologia Cl&#237;nica&#44; October 23&#8211;24&#44; 2015&#44; St&#46; Hilari Sacalm&#44; Spain&#59; and at the XX National Congress of the Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica&#44; May 26&#8211;28&#44; 2016&#44; Barcelona&#44; Spain&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Adults &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Tests performed<br>Sex</td><td class="td" title="table-entry  " align="left" valign="top">998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">298 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">700 &#40;70&#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  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">311 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">151 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">160 &#40;23&#41;&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>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">687 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">147 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">540 &#40;77&#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="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">IgG-positive<br>Sex</td><td class="td" title="table-entry  " align="left" valign="top">597 &#40;60&#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">467 &#40;67&#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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">180 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">112 &#40;24&#41;&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>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">417 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;48&#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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">12 &#40;18&#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">38 &#40;95&#41;&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The 65 assays positive for IgM corresponded to 56 patients&#59; 2 serologic tests were performed in 9 patients &#40;3 children and 6 adults&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Serologic tests performed between 2010 and 2015&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
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          "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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">Total<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&nbsp;\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">Children<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22 &#40;39&#37;&#41;&nbsp;\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">Adults<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34 &#40;61&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Mean age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 years<br>&#40;0&#46;5&#8211;12 years&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><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="left" valign="top">42 years<br>&#40;25&#8211;63 years&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex</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>Male &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;6&#41;&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>Female &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;94&#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="4" 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="elsevierStyleItalic">IgM-positive &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;100&#41;&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="elsevierStyleItalic">IgG-positive &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2022425.png"
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            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Age range of patients&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Age&#44; sex and serologic findings in the 56 patients with acute infection by <span class="elsevierStyleItalic">Erythrovirus B19</span>&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
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        "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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">Total<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56 &#40;&#37;&#41;&nbsp;\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">Children<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22 &#40;&#37;&#41;&nbsp;\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">Adults<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34 &#40;&#37;&#41;&nbsp;\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"><span class="elsevierStyleItalic">Fever</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 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;32&#41;&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="elsevierStyleItalic">Rash</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;29&#41;&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="elsevierStyleItalic">Gastrointestinal symptoms</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 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#41;&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="elsevierStyleItalic">Arthralgia</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 &#40;41&#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 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;59&#41;&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="elsevierStyleItalic">Lymphadenopathy</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 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;12&#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="4" 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="elsevierStyleItalic">Anaemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;46&#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 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;41&#41;&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>Mild &#40;91&#8211;120<span class="elsevierStyleHsp" style=""></span>g&#47;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">19 &#40;73&#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 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;79&#41;&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>Moderate &#40;60&#8211;90<span class="elsevierStyleHsp" style=""></span>g&#47;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 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#41;&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>Severe &#40;&#60;60<span class="elsevierStyleHsp" style=""></span>g&#47;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">4 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;14&#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="4" 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="elsevierStyleItalic">Elevated CRP &#40;&#62;0&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#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">27 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;47&#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="4" 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="elsevierStyleItalic">Abnormal WBC count</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 &#40;25&#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 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;18&#41;&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>Leukopenia &#40;&#60;4000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>cells&#47;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">4 &#40;29&#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 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;17&#41;&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>Leucocytosis<a class="elsevierStyleCrossRef" href="#tblfn0015"><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">10 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;83&#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="4" 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="elsevierStyleItalic">Thrombocytopenia &#40;&#60;130</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">000</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#215;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">10</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">6</span></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cells&#47;L&#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 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2022427.png"
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            0 => array:3 [
              "identificador" => "tblfn0015"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Leucocytosis&#58; WBC &#62;17<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;L in patients aged &#60;6 years&#59; &#62;14<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;L in patients aged 6&#8211;16 years and &#62;11<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;L in patients aged &#62;16 years&#46;</p>"
            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Clinical and laboratory characteristics of the patients&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8212;&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>Moderate &#40;60&#8211;90<span class="elsevierStyleHsp" style=""></span>g&#47;L&#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="char" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8212;&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>Severe &#40;&#60;60<span class="elsevierStyleHsp" style=""></span>g&#47;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">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;100&#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="4" 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="elsevierStyleItalic">Elevated CRP &#40;&#62;0&#46;5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#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">11 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;50&#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="4" 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="elsevierStyleItalic">Abnormal WBC count</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;100&#41;&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>Leukopenia &#40;&#60;4000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>cells&#47;L&#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="char" valign="top">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8212;&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>Leucocytosis &#40;&#62;11<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>cells&#47;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 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;100&#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="char" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical and laboratory characteristics of adult patients with infection by <span class="elsevierStyleItalic">Erythrovirus B19</span> &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41; based on the presence or absence of a relevant clinical history&#44; excluding pregnant women&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="https://www.seimc.org/contenidos/ccs/revisionestematicas/serologia/ErythroB19.pdf">https&#58;&#47;&#47;www&#46;seimc&#46;org&#47;contenidos&#47;ccs&#47;revisionestematicas&#47;serologia&#47;ErythroB19&#46;pdf</a> &#91;accessed 15&#46;07&#46;16&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagn&#243;stico microbiol&#243;gico de la infecci&#243;n por Erythovirus B19&#46; Documento Control Calidad SEIMC"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;M&#46; Garc&#237;a-Tapia"
                            1 => "M&#46;C&#46; Lozano Dom&#237;nguez"
                            2 => "C&#46; Fern&#225;ndez Guti&#233;rrez del &#193;lamo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Libro" => array:1 [
                        "fecha" => "2005"
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available from&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="https://www.aepap.org/sites/default/files/documento/archivos-adjuntos/parvovirus_2_1.pdf">https&#58;&#47;&#47;www&#46;aepap&#46;org&#47;sites&#47;default&#47;files&#47;documento&#47;archivos-adjuntos&#47;parvovirus&#95;2&#95;1&#46;pdf</a> &#91;accessed 15&#46;07&#46;16&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infecci&#243;n por Parvovirus B19 y Embarazo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Rodr&#237;guez Arranz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2015"
                        "editorial" => "Grupo de Patolog&#237;a Infecciosa de AEPap"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical presentations of parvovirus B19 infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;T&#46; Servey"
                            1 => "B&#46;V&#46; Reamy"
                            2 => "J&#46; Hodge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am Fam Physician"
                        "fecha" => "2007"
                        "volumen" => "75"
                        "paginaInicial" => "373"
                        "paginaFinal" => "376"
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                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parvovirus B19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;L&#46; Landry"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/microbiolspec.DMIH2-0008-2015"
                      "Revista" => array:3 [
                        "tituloSerie" => "Microbiol Spectr"
                        "fecha" => "2016"
                        "volumen" => "4"
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                  ]
                ]
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            4 => array:3 [
              "identificador" => "bib0065"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Toxoplasmosis&#44; parvovirus&#44; and cytomegalovirus in pregnancy"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;M&#46; Feldman"
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                            2 => "A&#46;F&#46; Borgida"
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                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Lab Med"
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                        "paginaFinal" => "419"
                      ]
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              "identificador" => "bib0070"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Common childhood viral infections"
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                          "autores" => array:5 [
                            0 => "S&#46;J&#46; Alter"
                            1 => "J&#46;S&#46; Bennett"
                            2 => "K&#46; Koranyi"
                            3 => "A&#46; Kreppel"
                            4 => "R&#46; Simon"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Probl Pediatr Adolesc Health Care"
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                      "titulo" => "TORCH infections"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Neu"
                            1 => "J&#46; Duchon"
                            2 => "P&#46; Zachariah"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Perinatol"
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                      "titulo" => "ACOG practice bulletin&#46; Perinatal viral and parasitic infections"
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                            0 => "American College of Obstetrics&#44; Gynecologists"
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                      ]
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2018.05.008

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Year/Month	Html	Pdf	Total

2024 November	6	6	12
2024 October	44	42	86
2024 September	54	32	86
2024 August	49	58	107
2024 July	55	33	88
2024 June	69	38	107
2024 May	43	30	73
2024 April	43	27	70
2024 March	40	27	67
2024 February	44	26	70
2024 January	35	22	57
2023 December	55	19	74
2023 November	40	36	76
2023 October	43	19	62
2023 September	23	29	52
2023 August	27	9	36
2023 July	24	24	48
2023 June	37	30	67
2023 May	47	23	70
2023 April	32	14	46
2023 March	56	27	83
2023 February	43	28	71
2023 January	32	22	54
2022 December	74	27	101
2022 November	47	29	76
2022 October	60	51	111
2022 September	27	24	51
2022 August	49	46	95
2022 July	37	48	85
2022 June	35	31	66
2022 May	52	31	83
2022 April	40	32	72
2022 March	50	63	113
2022 February	62	35	97
2022 January	50	21	71
2021 December	51	41	92
2021 November	55	46	101
2021 October	98	58	156
2021 September	49	28	77
2021 August	46	35	81
2021 July	87	26	113
2021 June	84	43	127
2021 May	70	32	102
2021 April	164	96	260
2021 March	69	31	100
2021 February	65	25	90
2021 January	66	24	90
2020 December	53	13	66
2020 November	55	25	80
2020 October	134	9	143
2020 September	174	18	192
2020 August	129	10	139
2020 July	112	12	124
2020 June	74	11	85
2020 May	90	21	111
2020 April	74	18	92
2020 March	92	15	107
2020 February	70	885	955
2020 January	52	9	61
2019 December	83	26	109
2019 November	49	5	54
2019 October	55	11	66
2019 September	80	12	92
2019 August	94	16	110
2019 July	71	28	99
2019 June	81	30	111
2019 May	142	26	168
2019 April	39	26	65

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