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phenotypic and genotypic data&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> These data include the verification that the frequency of symptoms increases as the parasite burden increases&#44; the disappearance of symptoms after antiparasitic therapy&#44; the morphological differences between the forms of <span class="elsevierStyleItalic">B&#46; hominis</span> isolated in symptomatic and asymptomatic patients and the presence of various subtypes of the parasite according to the symptoms produced&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to report the clinical&#44; epidemiological and analytical characteristics of patients with parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> in a tropical medicine unit &#40;TMU&#41; located in one of the areas of Spain with the largest immigrant population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">An observational retrospective study was conducted on all patients diagnosed with parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> from October 2004 to March 2016 in the TMU of Hospital de Poniente in El Ejido &#40;Almeria&#44; Spain&#41;&#46; The TMU is a reference unit for a population of 287&#44;000 inhabitants&#44; 30&#37; of whom are foreigners&#44; mostly immigrants &#40;50&#37; from Africa&#41;&#46; To conduct the study&#44; we collected demographic&#44; epidemiological&#44; clinical and analytical data from each patient&#46; We performed an initial statistical analysis of all patients in whom this parasite was isolated&#46; A second analysis was then performed of only those with parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> with no other parasitic co-infections&#44; which was defined as the presence of <span class="elsevierStyleItalic">B&#46; hominis</span> along with 1 or more distinct pathogenic parasites&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A complete case history review that included epidemiological aspects was performed for all patients&#46; During the initial visit&#44; laboratory tests were requested that included a full blood count and biochemistry with a hepatic and renal profile and IgE readings&#46; If not available beforehand&#44; serology was requested for the hepatitis B virus&#44; hepatitis <span class="elsevierStyleSmallCaps">C</span> virus&#44; human immunodeficiency virus&#44; syphilis&#44; <span class="elsevierStyleItalic">Schistosoma</span> infection &#40;NovaLisa&#8482; Schistosoma mansoni IgG ELISA Kit&#44; NovaTec Immunodiagnostica GmbH&#44; Dietzenbach&#44; Germany&#41; and&#44; depending on the patient&#39;s origin&#44; <span class="elsevierStyleItalic">Strongyloides</span> infection &#40;ELISA kit PALEX Medical SA&#8482;&#44; Ref&#46; EIA-4208&#44; DRG Diagnostics&#44; Germany&#41;&#46; To study the parasites in feces&#44; we employed the Ritchie concentration technique on 3 samples collected on alternate days&#44; repeating up to 3 sets of 3 samples for the patients without an initial diagnosis&#46; The study of parasites in urine was performed for the patients from endemic areas of urinary schistosomiasis&#46; The diagnosis of schistosomiasis was performed when the parasite&#39;s eggs were isolated in feces&#44; urine or biopsy material&#46; For the patients from areas of high prevalence&#44; we performed a microfilariae study in blood using the Knott test&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis of parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> was performed when the parasite was observed in feces&#46; In the subgroup without parasitic co-infection&#44; all patients with isolates of other parasites in blood&#44; feces or urine were excluded&#44; except those with parasites considered nonpathogenic such as <span class="elsevierStyleItalic">Entamoeba coli</span>&#44; <span class="elsevierStyleItalic">Endolimax nana</span> or <span class="elsevierStyleItalic">Dicrocoelium dendriticum</span>&#46; In terms of its pathogenicity&#44; <span class="elsevierStyleItalic">Dicrocoelium</span> is known to produce spurious or false parasitoses in which the human is invaded but not colonized&#44; because the eggs in feces disappear after the individual stops eating the contaminated food&#44; without producing symptoms&#46; In our series&#44; we showed that all were false parasitoses&#44; and therefore the patients with <span class="elsevierStyleItalic">Dicrocoelium</span> isolates were not excluded from this subgroup&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the symptomatic patients &#40;abdominal pain&#44; diarrhea or pruritus&#41; in whom no other parasitosis was found or for whom the symptoms persisted after treating other parasitoses&#44; we assumed that <span class="elsevierStyleItalic">B&#46; hominis</span> was the causal agent for the symptoms&#46; As first-line antiparasitic therapy&#44; we used 500&#8211;750<span class="elsevierStyleHsp" style=""></span>mg of metronidazole every 8<span class="elsevierStyleHsp" style=""></span>h for 7&#8211;10 days&#46; The second-line therapy was 160<span class="elsevierStyleHsp" style=""></span>mg&#47;800<span class="elsevierStyleHsp" style=""></span>mg of trimethoprim-sulfamethoxazole every 12<span class="elsevierStyleHsp" style=""></span>h for 7 days&#46; A subsequent check-up was performed at 6&#8211;12 weeks&#46; The cure criterion was the disappearance of the parasite in feces or symptom resolution in the cases in which a parasite check could not be performed&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">For the data analysis&#44; we employed the Statistical Package for the Social Sciences &#40;SPSS&#41;&#44; version 15&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#44; using the mean as the measure of central tendency&#59; we used the range and standard deviation as the measure of dispersion&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This study was approved by the Clinical Research Ethics Committee of Almeria &#40;code 3&#47;2018&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 3070 patients treated in the Tropical Medicine office&#44; 570 &#40;18&#37;&#41; were diagnosed with <span class="elsevierStyleItalic">B&#46; hominis</span> infection&#59; of these&#44; 477 &#40;83&#46;7&#37;&#41; were male patients&#46; The mean age of the patients was 31 years &#40;range&#44; 6&#8211;77&#41;&#46; For the immigrants&#44; the mean length of stay in Spain was 52 months &#40;range&#44; 0&#8211;348&#41;&#46; The main countries of origin were the following&#58; Senegal &#40;159&#44; 28&#37;&#41;&#44; Mali &#40;103&#44; 18&#37;&#41;&#44; Guinea-Bissau &#40;68&#44; 12&#37;&#41;&#44; Morocco &#40;61&#44; 11&#37;&#41;&#44; Mauritania &#40;37&#44; 6&#37;&#41; and Gambia &#40;21&#44; 4&#37;&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Among the 570 patients with <span class="elsevierStyleItalic">B&#46; hominis</span> colonization&#44; there were 18 Spaniards &#40;3&#46;1&#37;&#41;&#44; 2 of whom were expats &#40;residents of Mexico and the Democratic Republic of Congo&#41; and 7 of whom were travelers with different destination countries&#46; The remaining 9 had not recently traveled internationally &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The patients were referred from primary care &#40;429&#59; 75&#46;3&#37;&#41; and internal medicine &#40;42&#59; 7&#46;4&#37;&#41; and gastroenterology &#40;38&#59; 6&#46;7&#37;&#41; departments&#46; Among the 245 patients &#40;43&#37;&#41; with exclusively <span class="elsevierStyleItalic">B&#46; hominis</span> isolates&#44; the main reasons for the referral were very similar to those of the group with parasitic co-infections &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Of the 325 &#40;57&#37;&#41; patients with parasitic co-infections&#44; the most common parasites were <span class="elsevierStyleItalic">Entamoeba histolytica</span> &#40;<span class="elsevierStyleItalic">E&#46; histolytica</span>&#41;&#47;<span class="elsevierStyleItalic">dispar</span> &#40;144&#59; 25&#46;3&#37;&#41;&#44; <span class="elsevierStyleItalic">Strongyloides stercoralis</span> &#40;<span class="elsevierStyleItalic">S&#46; stercoralis</span>&#41; &#40;99&#59; 17&#46;4&#37;&#41;&#44; hookworm &#40;66&#59; 11&#46;6&#37;&#41; and schistosomiasis &#40;48&#59; 8&#46;4&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the first visit&#44; the group of 570 patients with <span class="elsevierStyleItalic">B&#46; hominis</span> infection had a mean eosinophil blood count of 374&#46;6<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;L &#40;range&#44; 5&#8211;3202&#41; and a mean IgE level of 17&#46;11<span class="elsevierStyleHsp" style=""></span>IU&#47;mL &#40;range&#44; 3&#46;6&#8211;11&#44;860&#46;9&#41;&#46; In the first visit&#44; the patients with no parasitic co-infection had a mean total eosinophil blood count of 271&#46;2<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;L &#40;range&#44; 5&#8211;3202&#41; and a mean IgE level of 458<span class="elsevierStyleHsp" style=""></span>IU&#47;mL &#40;range&#44; 3&#46;6&#8211;7816&#41;&#46; <span class="elsevierStyleItalic">B&#46; hominis</span> was isolated in the first batch of feces from 215 &#40;87&#46;7&#37;&#41; of these patients&#46; Of the 30 remaining patients&#44; 26 &#40;10&#46;6&#37;&#41; were diagnosed in the second batch&#44; and 4 &#40;1&#46;6&#37;&#41; were diagnosed in the third&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Among the 23 patients with exclusively <span class="elsevierStyleItalic">B&#46; hominis</span> isolates and eosinophilia &#40;total eosinophil count &#62;450<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;L&#41;&#44; possible alternative causes for the eosinophilia were found&#58; 3 of the patients had vasculitis with positive antineutrophil cytoplasmic antibodies&#44; bronchial asthma and primary biliary cirrhosis&#47;primary sclerosing cholangitis&#59; IgG serology results showed <span class="elsevierStyleItalic">Schistosoma</span> in 4 patients&#44; although the eosinophilia persisted despite treatment with praziquantel&#59; in 5 cases&#44; the eosinophilia was transient&#59; 6 patients underwent empiric treatment with albendazole&#44; praziquantel and ivermectin&#44; after a negative parasitological study&#44; and the eosinophilia disappeared in 4 of them&#59; finally&#44; 5 cases were lost during the follow-up&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 245 patients with exclusive <span class="elsevierStyleItalic">B&#46; hominis</span> isolates&#44; antiparasitic therapy was prescribed for 42 symptomatic patients&#46; Nineteen cases were lost during the follow-up&#46; Of the remaining 23 patients&#44; 18 &#40;78&#46;2&#37;&#41; improved clinically&#44; and the parasites in feces were neutralized in 19 &#40;82&#46;6&#37;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> is highly prevalent in patients treated in a TMU&#46; The infection mainly affects immigrants&#44; and many of the cases are asymptomatic&#46; In the symptomatic patients&#44; the clinical manifestations can be attributed in most cases to other concomitant parasitoses&#46; However&#44; when there is no other cause that explains the symptoms&#44; treatment with metronidazole resolves or improves the symptoms and eliminates the parasite in a significant number of patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> is especially frequent in economically depressed populations of tropical and subtropical regions&#46; Among the patients treated in our unit&#44; the prevalence of parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> was 18&#37;&#44; a rate very similar to that measured in the multicenter study by El Safadi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> on a French population &#40;18&#46;1&#37;&#41; of mostly sub-Saharan immigrants&#46; These readings vary substantially in other regions&#46; For example&#44; in the study by Scanlan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> in the United States&#44; the prevalence was 7&#37; due to the smaller immigrant population&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Although most of the patients included in our series came from countries with low levels of development&#44; 18 patients &#40;3&#46;2&#37;&#41; were Spanish&#44; 40&#37; of whom had traveled to various countries with deficient hygiene-sanitary conditions&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Blastocystosis is a zoonosis transmitted from animals to humans&#44; although intraindividual contagion is possible&#46; In both cases&#44; this transmission involves a fecal-oral mechanism&#44; through water or food contaminated with the parasite&#39;s cysts&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> In native cases&#44; the transmission mechanism is difficult to establish&#44; although a number of patients in the present study had consumed water from untreated natural springs&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The most common symptoms related to <span class="elsevierStyleItalic">B&#46; hominis</span> infection are abdominal pain&#44; diarrhea&#44; flatulence&#44; asthenia and weight loss&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;6</span></a> As with other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7&#44;8</span></a> the main referral symptoms in our study were abdominal pain and diarrhea&#46; Less common were urticarial symptoms &#40;acute and chronic&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9&#44;10</span></a> with no other cause that could explain them and that resolved after the start of antiparasitic therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10&#44;11</span></a> In our study&#44; 18 patients &#40;7&#46;3&#37;&#41; presented pruritus&#44; and 6 &#40;2&#46;4&#37;&#41; presented urticarial manifestations&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">There are studies that have indicated a relationship between the infectious <span class="elsevierStyleItalic">B&#46; hominis</span> subtype and the clinical expression&#44; such that subtypes 1 and 3 are related to gastrointestinal manifestations&#44; with subtype 3 prevalent in humans&#44; while subtypes 2 and 4 are related to urticarial conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Another frequent reason for referral was eosinophilia&#44; which was present in 73 patients &#40;12&#46;8&#37;&#41; with parasitic co-infections and in 23 &#40;9&#46;4&#37;&#41; with exclusively <span class="elsevierStyleItalic">B&#46; hominis</span> parasitosis&#44; as reflected in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Among the patients with parasitic co-infections&#44; eosinophilia could be explained by the presence of the other parasites&#44; mainly helminths such as <span class="elsevierStyleItalic">Schistosoma</span>&#44; <span class="elsevierStyleItalic">S&#46; stercoralis</span>&#44; hookworm&#44; <span class="elsevierStyleItalic">Ascaris lumbricoides</span> and <span class="elsevierStyleItalic">Trichuris trichiura</span>&#46; In the patients with exclusively <span class="elsevierStyleItalic">B&#46; hominis</span> isolates&#44; the eosinophilia could be due to the presence of undiagnosed helminthiasis&#44; after reasonably ruling out the other causes &#40;medication&#44; allergic processes&#44; <span class="elsevierStyleItalic">etc&#46;</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleItalic">B&#46; hominis</span> does not produce eosinophilia but rather acts by increasing interleukin production &#40;4&#44; 5 and 13&#44; among others&#41;&#44; resulting in IgE-mediated reactions&#44; with the participation of mast cells and basophils but not eosinophils&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> In a study conducted by Zaki et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> on children with parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span>&#44; an association between this parasite and the presence of eosinophilia could not be demonstrated&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The screening of imported diseases in the immigrant population&#44; implemented in primary care&#44; helps identify parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> in a considerable proportion of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">15&#44;16</span></a> In our study&#44; 75&#46;3&#37; of the patients were referred from primary care&#44; and parasitosis by <span class="elsevierStyleItalic">B&#46; hominis</span> was diagnosed in 31&#37; of the patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In terms of the antiparasitic therapy for patients with <span class="elsevierStyleItalic">B&#46; hominis</span> isolates&#44; most studies conclude that it is not necessary for asymptomatic patients&#46; For symptomatic patients&#44; the recommendation is to rule out other possible etiologies&#46; Therapy is warranted when the patient is symptomatic and there are no other causes that explain the symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">17&#8211;19</span></a> In this study&#44; a high percentage of the 42 treated patients showed cure criteria&#44; with symptoms disappearing in 78&#37; of the cases and neutralization of the parasite in feces in 83&#37;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The efficacy of treatment against <span class="elsevierStyleItalic">B&#46; hominis</span> is debatable&#46; In the series by Nigro et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> symptoms disappeared in 88&#37; of the patients treated with metronidazole compared with only 14&#37; of the placebo group&#46; In contrast&#44; in a study with 18 patients treated with metronidazole&#44; iodoquinol or triple therapy &#40;nitazoxanide&#44; furazolidone and secnidazole&#41;&#44; the symptoms and the parasite isolates in feces persisted&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> A subsequent study observed a low susceptibility of the parasite to metronidazole&#44; suggesting trimethoprim-sulfamethoxazole or ivermectin as possible alternatives&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Silva-D&#237;az et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> found a good response to treatment with metronidazole and nitazoxanide but resistance to treatment with trimethoprim-sulfamethoxazole and erythromycin&#46; These conflicting results could be partly explained by the parasite&#39;s varying susceptibility depending on the selective antimicrobial pressure in each population&#46; New studies are therefore needed to determine the efficacy of the various antimicrobials against <span class="elsevierStyleItalic">B&#46; hominis</span>&#44; more <span class="elsevierStyleItalic">in vivo</span> than <span class="elsevierStyleItalic">in vitro</span>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our study&#39;s limitations include our laboratory&#39;s inability to differentiate <span class="elsevierStyleItalic">E&#46; histolytica</span> from <span class="elsevierStyleItalic">E&#46; dispar</span> and the significant number of patients who were lost during the subsequent follow-up &#40;45&#37;&#41;&#44; which impedes the assessment of the efficacy of the antiparasitic therapy&#46; Lastly&#44; given our study&#39;s retrospective character&#44; we only included patients referred to a reference unit&#46; The actual prevalence of this parasitosis could have therefore been overestimated&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; <span class="elsevierStyleItalic">B&#46; hominis</span> is one of the most common intestinal parasites diagnosed in sub-Saharan immigrants in our community&#46; The implementation of specific protocols in the initial care of immigrant patients helps detect a high number of asymptomatic patients and treat those patients in whom <span class="elsevierStyleItalic">B&#46; hominis</span> could be causing the symptoms&#46; Treatment with metronidazole appears to be effective&#44; both in eradicating the parasite and in the disappearance of the symptoms&#46; We need to develop techniques that help us determine the parasite&#39;s pathogenicity and identify the pathogenic strains&#44; the various subtypes and their geographical distribution&#44; their hosts and their relationship with the resulting clinical conditions&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            1 => "Intestinal parasitosis"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Blastocystis hominis</span> &#40;<span class="elsevierStyleItalic">B&#46; hominis</span>&#41; is one of the most common intestinal parasites isolated in humans&#46; The parasite can cause gastrointestinal symptoms or&#44; in most cases&#44; remain asymptomatic&#46; There are issues concerning the parasite&#39;s pathogenic character&#46; The aim of this study was to analyze the clinical and epidemiological characteristics of the parasite infection by B&#46; hominis&#44; with or without other parasitic co-infections&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational retrospective study was conducted of <span class="elsevierStyleItalic">B&#46; hominis</span> isolates in feces from October 2004 to March 2016 in a tropical medicine unit&#46; We reviewed all patients with a parasite infection&#44; exclusively or not by <span class="elsevierStyleItalic">B&#46; hominis</span>&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied 3070 patients&#44; 570 &#40;18&#37;&#41; of whom were diagnosed with B&#46; hominis infection&#44; which was the only isolate in 245 &#40;43&#37;&#41; of the 570 patients&#46; A total of 325 &#40;57&#37;&#41; patients presented other parasitic co-infections &#40;<span class="elsevierStyleItalic">Entamoeba histolytic</span> or <span class="elsevierStyleItalic">Entamoeba dispar</span>&#44; <span class="elsevierStyleItalic">Strongyloides stercoralis</span>&#44; hookworm and <span class="elsevierStyleItalic">Schistosoma</span> spp&#46;&#41;&#46; The main symptom was abdominal pain &#40;41&#46;8&#37;&#41;&#46; In 31&#46;2&#37; of cases&#44; the parasite was detected in the imported diseases screening of asymptomatic patients&#46; Of those who underwent treatment with metronidazole&#44; 78&#46;2&#37; improved&#46; The parasite was neutralized in 82&#46;6&#37; of the patients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Parasite infection by <span class="elsevierStyleItalic">B&#46; hominis</span> is one of the most common diseases in our tropical medicine unit&#46; Most patients are asymptomatic&#44; or their symptoms can be attributed to other parasite infections&#46; In those cases in which symptoms persist without being able to attribute them to other causes&#44; a specific treatment is recommended&#46;</p></span>"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Blastocystis hominis &#40;B&#46; hominis&#41;</span> es uno de los par&#225;sitos intestinales m&#225;s frecuentemente aislados en el ser humano&#46; Puede producir sintomatolog&#237;a gastrointestinal o&#44; en la mayor&#237;a de los casos&#44; permanecer asintom&#225;tico&#46; Existen dudas sobre el car&#225;cter pat&#243;geno del par&#225;sito&#46; El objetivo de este estudio fue analizar las caracter&#237;sticas cl&#237;nicas y epidemiol&#243;gicas de la parasitaci&#243;n por <span class="elsevierStyleItalic">B&#46; hominis</span>&#44; con y sin otras coparasitaciones&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo de aislamientos de <span class="elsevierStyleItalic">B&#46; hominis</span> en heces&#44; desde octubre del 2004 hasta marzo del 2016 en una Unidad de Medicina Tropical&#46; Se revis&#243; a todos los pacientes con parasitaci&#243;n exclusiva&#44; o no&#44; por <span class="elsevierStyleItalic">B&#46; hominis</span>&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 3&#46;070 pacientes&#46; En 570 &#40;18&#37;&#41; se diagnostic&#243; infecci&#243;n por <span class="elsevierStyleItalic">B&#46; hominis</span>&#44; de los que en 245 &#40;43&#37;&#41; represent&#243; el &#250;nico aislamiento&#59; 325 &#40;57&#37;&#41; presentaron otras coparasitaciones <span class="elsevierStyleItalic">&#40;Entamoeba hystolitica</span> o dispar&#44; <span class="elsevierStyleItalic">Strongyloides stercoralis</span>&#44; uncinarias y <span class="elsevierStyleItalic">Schistosoma</span> sp&#46;&#41;&#46; El s&#237;ntoma principal fue dolor abdominal &#40;41&#44;8&#37;&#41;&#46; En un 31&#44;2&#37; el par&#225;sito se detect&#243; en el cribado de enfermedades importadas en pacientes asintom&#225;ticos&#46; De los que recibieron tratamiento con metronidazol&#44; un 78&#44;2&#37; mejor&#243; y en el 82&#44;6&#37; los par&#225;sitos se negativizaron&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La parasitaci&#243;n por <span class="elsevierStyleItalic">B&#46; hominis</span> es una de las enfermedades m&#225;s frecuentes en nuestra Unidad de Medicina Tropical&#46; La mayor&#237;a de los pacientes est&#225;n asintom&#225;ticos o bien la cl&#237;nica puede ser atribuida a otras parasitaciones&#46; En aquellos casos en los que persisten los s&#237;ntomas sin poder ser atribuidos a otras causas&#44; es recomendable un tratamiento espec&#237;fico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Oca&#241;a-Losada C&#44; Cuenca-G&#243;mez JA&#44; Cabezas-Fern&#225;ndez MT&#44; V&#225;zquez-Villegas J&#44; Soriano-P&#233;rez MJ&#44; Cabeza-Barrera I&#44; et al&#46; Caracter&#237;sticas cl&#237;nicas y epidemiol&#243;gicas de la parasitaci&#243;n intestinal por <span class="elsevierStyleItalic">Blastocystis hominis</span>&#46; Rev Clin Esp&#46; 2018&#59;218&#58;115-120&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This study was conducted within the activities implemented by the research group CTS 582 of the Ministry of Health of the Government of Andalusia&#44; the Cooperative Research Network on Tropical Diseases &#40;RICET&#41; and the Center for the Study of Migrations and Intercultural Relationships &#40;CEMyRI&#41; of the University of Almeria&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      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:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&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">Age&#44; years&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">Traveler&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">Countries visited&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">Symptoms&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">Parasitic co-infections&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">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytica</span>&#47;<span class="elsevierStyleItalic">dispar</span>&#44; <span class="elsevierStyleItalic">Giardia lamblia</span>&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Costa Rica&#44; Panama&#44; United States&#44; Peru&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Giardia lamblia</span>&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diarrhea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Endolimax nana</span>&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Expatriates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mexico &#40;Veracruz&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diarrhea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Expatriates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Democratic Republic of Congo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Arthromylagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diarrhea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytica</span>&#47;<span class="elsevierStyleItalic">dispar</span>&#44; <span class="elsevierStyleItalic">Giardia lamblia</span>&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Morocco &#40;Casablanca&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytic</span>&#47;<span class="elsevierStyleItalic">dispar</span>&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">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ethiopia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Schistosoma</span> spp&#46;&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">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Entamoeba histolytic</span>&#47;<span class="elsevierStyleItalic">dispar</span>&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uzbekistan&#44; Egypt&#44; Tunisia&#44; Jordan&#44; Brazil&#44; Israel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pruritus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Strongyloides stercoralis</span>&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diarrhea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pruritus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pruritus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mexico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&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">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diarrhea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Spanish patients infected by <span class="elsevierStyleItalic">Blastocystis hominis</span>&#46;</p>"
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        "etiqueta" => "Table 2"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" 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">With parasitic co-infections&#44; <span class="elsevierStyleItalic">n</span> &#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">Without parasitic co-infections&#44; <span class="elsevierStyleItalic">n</span> &#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">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">238 &#40;41&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;36&#46;3&#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">Screening of asymptomatic patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">178 &#40;31&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;28&#46;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">Eosinophilia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;12&#46;8&#41;&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;9&#46;4&#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">Hepatic disorders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;15&#46;5&#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">Pruritus&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;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;7&#46;3&#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">Diarrhea&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;4&#46;6&#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;4&#46;9&#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">Skin lesions&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;2&#46;1&#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;2&#46;4&#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">Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;1&#46;6&#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;2&#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">Adenopathies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;1&#46;6&#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;1&#46;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">Macrohematuria&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;1&#46;4&#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;0&#46;8&#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">Anemia&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;1&#46;1&#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;2&#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">Arthromylagia&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;0&#46;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">3 &#40;1&#46;2&#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">Radiological lesion&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;0&#46;7&#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;0&#46;4&#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">Neurological abnormalities&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;0&#46;5&#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;0&#46;8&#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">Ophthalmologic abnormalities&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;0&#46;4&#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;0&#46;4&#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">Microhematuria&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;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&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">Other reasons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Reasons for referral of patients with <span class="elsevierStyleItalic">Blastocystis hominis</span> isolates&#44; with or without parasitic co-infections&#46;</p>"
        ]
      ]
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parasite&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"><span class="elsevierStyleItalic">n</span>&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">&#37;&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">Entamoeba histolytic</span>&#47;<span class="elsevierStyleItalic">dispar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">144&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;3&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">Strongyloides stercoralis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;4&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">Hookworm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;6&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">Schistosoma</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;4&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">Endolimax nana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Giardia lamblia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&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">Hymenolepis nana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&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">Trichuris trichiura</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&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">Cryptosporidium</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&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">Ascaris lumbricoides</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&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">Enterobius vermicularis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&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">Taenia</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Intestinal parasitic co-infections found in the study patients&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:22 [
            0 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infecci&#243;n por <span class="elsevierStyleItalic">Blastocystis</span> sp&#46;&#44; revisi&#243;n de la literatura"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Ca&#241;ete"
                            1 => "P&#46; Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Med Electr&#243;n"
                        "fecha" => "2012"
                        "volumen" => "34"
                        "paginaInicial" => "556"
                        "paginaFinal" => "565"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
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Original article
Clinical and epidemiological characteristics of intestinal parasite infection by Blastocystis hominis
Características clínicas y epidemiológicas de la parasitación intestinal por Blastocystis hominis
C. Ocaña-Losadaa,
Corresponding author
crstnol.89@gmail.com

Corresponding author.
, J.A. Cuenca-Gómeza,b, M.T. Cabezas-Fernándeza,b,c, J. Vázquez-Villegasb,d, M.J. Soriano-Péreza,b, I. Cabeza-Barreraa,b, J. Salas-Coronasa,b,c
a Unidad de Medicina Tropical, Hospital de Poniente, El Ejido, Almería, Spain
b RICET (Red de Investigación Cooperativa en Enfermedades Tropicales), Spain
c CEMyRI (Centro de Estudios de las Migraciones y Relaciones Interculturales), Universidad de Almería, Almería, Spain
d Unidad de Medicina Tropical, Distrito Poniente, Almería, Spain
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