Share
array:24 [
"pii" => "S2254887419301298"
"issn" => "22548874"
"doi" => "10.1016/j.rceng.2019.04.006"
"estado" => "S300"
"fechaPublicacion" => "2020-03-01"
"aid" => "1676"
"copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
"copyrightAnyo" => "2019"
"documento" => "article"
"crossmark" => 1
"subdocumento" => "sco"
"cita" => "Rev Clin Esp. 2020;220:109-14"
"abierto" => array:3 [
"ES" => false
"ES2" => false
"LATM" => false
]
"gratuito" => false
"lecturas" => array:1 [
"total" => 0
]
"Traduccion" => array:1 [
"es" => array:19 [
"pii" => "S0014256519301468"
"issn" => "00142565"
"doi" => "10.1016/j.rce.2019.04.008"
"estado" => "S300"
"fechaPublicacion" => "2020-03-01"
"aid" => "1676"
"copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
"documento" => "article"
"crossmark" => 1
"subdocumento" => "sco"
"cita" => "Rev Clin Esp. 2020;220:109-14"
"abierto" => array:3 [
"ES" => false
"ES2" => false
"LATM" => false
]
"gratuito" => false
"lecturas" => array:2 [
"total" => 12
"formatos" => array:2 [
"HTML" => 6
"PDF" => 6
]
]
"es" => array:12 [
"idiomaDefecto" => true
"cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL BREVE</span>"
"titulo" => "Síndrome hemofagocítico asociado a infecciones: no tan infrecuente"
"tienePdf" => "es"
"tieneTextoCompleto" => "es"
"tieneResumen" => array:2 [
0 => "es"
1 => "en"
]
"paginas" => array:1 [
0 => array:2 [
"paginaInicial" => "109"
"paginaFinal" => "114"
]
]
"titulosAlternativos" => array:1 [
"en" => array:1 [
"titulo" => "Haemophagocytic syndrome associated with infections: Not so uncommon"
]
]
"contieneResumen" => array:2 [
"es" => true
"en" => true
]
"contieneTextoCompleto" => array:1 [
"es" => true
]
"contienePdf" => array:1 [
"es" => true
]
"autores" => array:1 [
0 => array:2 [
"autoresLista" => "F.F. Rodríguez Vidigal, A. Calvo Cano, M. Sánchez Sánchez, N. Nogales Muñoz, A. Vera Tomé, A. Muñoz Sanz"
"autores" => array:6 [
0 => array:2 [
"nombre" => "F.F."
"apellidos" => "Rodríguez Vidigal"
]
1 => array:2 [
"nombre" => "A."
"apellidos" => "Calvo Cano"
]
2 => array:2 [
"nombre" => "M."
"apellidos" => "Sánchez Sánchez"
]
3 => array:2 [
"nombre" => "N."
"apellidos" => "Nogales Muñoz"
]
4 => array:2 [
"nombre" => "A."
"apellidos" => "Vera Tomé"
]
5 => array:2 [
"nombre" => "A."
"apellidos" => "Muñoz Sanz"
]
]
]
]
]
"idiomaDefecto" => "es"
"Traduccion" => array:1 [
"en" => array:9 [
"pii" => "S2254887419301298"
"doi" => "10.1016/j.rceng.2019.04.006"
"estado" => "S300"
"subdocumento" => ""
"abierto" => array:3 [
"ES" => false
"ES2" => false
"LATM" => false
]
"gratuito" => false
"lecturas" => array:1 [
"total" => 0
]
"idiomaDefecto" => "en"
"EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301298?idApp=WRCEE"
]
]
"EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301468?idApp=WRCEE"
"url" => "/00142565/0000022000000002/v1_202002140803/S0014256519301468/v1_202002140803/es/main.assets"
]
]
"itemSiguiente" => array:19 [
"pii" => "S2254887420300151"
"issn" => "22548874"
"doi" => "10.1016/j.rceng.2020.01.001"
"estado" => "S300"
"fechaPublicacion" => "2020-03-01"
"aid" => "1787"
"copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
"documento" => "simple-article"
"crossmark" => 1
"subdocumento" => "edi"
"cita" => "Rev Clin Esp. 2020;220:115-6"
"abierto" => array:3 [
"ES" => false
"ES2" => false
"LATM" => false
]
"gratuito" => false
"lecturas" => array:1 [
"total" => 0
]
"en" => array:10 [
"idiomaDefecto" => true
"cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
"titulo" => "A novel coronavirus emerges"
"tienePdf" => "en"
"tieneTextoCompleto" => "en"
"paginas" => array:1 [
0 => array:2 [
"paginaInicial" => "115"
"paginaFinal" => "116"
]
]
"titulosAlternativos" => array:1 [
"es" => array:1 [
"titulo" => "Un nuevo coronavirus emerge"
]
]
"contieneTextoCompleto" => array:1 [
"en" => true
]
"contienePdf" => array:1 [
"en" => true
]
"autores" => array:2 [
0 => array:2 [
"autoresLista" => "J. Ena"
"autores" => array:1 [
0 => array:2 [
"nombre" => "J."
"apellidos" => "Ena"
]
]
]
1 => array:2 [
"autoresLista" => "R.P. Wenzel"
"autores" => array:1 [
0 => array:2 [
"nombre" => "R.P."
"apellidos" => "Wenzel"
]
]
]
]
]
"idiomaDefecto" => "en"
"Traduccion" => array:1 [
"es" => array:9 [
"pii" => "S0014256520300217"
"doi" => "10.1016/j.rce.2020.01.001"
"estado" => "S300"
"subdocumento" => ""
"abierto" => array:3 [
"ES" => true
"ES2" => true
"LATM" => true
]
"gratuito" => true
"lecturas" => array:1 [
"total" => 0
]
"idiomaDefecto" => "es"
"EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520300217?idApp=WRCEE"
]
]
"EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300151?idApp=WRCEE"
"url" => "/22548874/0000022000000002/v1_202002180732/S2254887420300151/v1_202002180732/en/main.assets"
]
"itemAnterior" => array:19 [
"pii" => "S2254887419302176"
"issn" => "22548874"
"doi" => "10.1016/j.rceng.2019.05.015"
"estado" => "S300"
"fechaPublicacion" => "2020-03-01"
"aid" => "1683"
"copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
"documento" => "article"
"crossmark" => 1
"subdocumento" => "fla"
"cita" => "Rev Clin Esp. 2020;220:100-8"
"abierto" => array:3 [
"ES" => false
"ES2" => false
"LATM" => false
]
"gratuito" => false
"lecturas" => array:1 [
"total" => 0
]
"en" => array:13 [
"idiomaDefecto" => true
"cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
"titulo" => "Prognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study"
"tienePdf" => "en"
"tieneTextoCompleto" => "en"
"tieneResumen" => array:2 [
0 => "en"
1 => "es"
]
"paginas" => array:1 [
0 => array:2 [
"paginaInicial" => "100"
"paginaFinal" => "108"
]
]
"titulosAlternativos" => array:1 [
"es" => array:1 [
"titulo" => "Utilidad pronóstica del electrocardiograma en pacientes hipertensos mayores de 65 años. Estudio FAPRES"
]
]
"contieneResumen" => array:2 [
"en" => true
"es" => true
]
"contieneTextoCompleto" => array:1 [
"en" => true
]
"contienePdf" => array:1 [
"en" => true
]
"resumenGrafico" => array:2 [
"original" => 0
"multimedia" => array:7 [
"identificador" => "fig0010"
"etiqueta" => "Figure 2"
"tipo" => "MULTIMEDIAFIGURA"
"mostrarFloat" => true
"mostrarDisplay" => false
"figura" => array:1 [
0 => array:4 [
"imagen" => "gr2.jpeg"
"Alto" => 1089
"Ancho" => 2971
"Tamanyo" => 127017
]
]
"descripcion" => array:1 [
"en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier curves to compare the rate of patient events according to the presence or absence of the left ventricular overload pattern (on the left) and complete left bundle branch block (on the right) in the baseline electrocardiogram for developing a major cardiovascular event. Abbreviation: CLBBB, complete left bundle branch block.</p>"
]
]
]
"autores" => array:1 [
0 => array:2 [
"autoresLista" => "P. Guedes Ramallo, P. Morillas Blasco, M.J. Gómez Martínez, L. Núñez Martínez, A. Romero Valero, F. Peris Castelló, F.M. Rodríguez Santiago, N. Vicente Ibarra, M.A. Quintanilla Tello, E. Castilla Cabanes, L. Fácila Rubio, V. Pallarés-Carratalá"
"autores" => array:12 [
0 => array:2 [
"nombre" => "P."
"apellidos" => "Guedes Ramallo"
]
1 => array:2 [
"nombre" => "P."
"apellidos" => "Morillas Blasco"
]
2 => array:2 [
"nombre" => "M.J."
"apellidos" => "Gómez Martínez"
]
3 => array:2 [
"nombre" => "L."
"apellidos" => "Núñez Martínez"
]
4 => array:2 [
"nombre" => "A."
"apellidos" => "Romero Valero"
]
5 => array:2 [
"nombre" => "F."
"apellidos" => "Peris Castelló"
]
6 => array:2 [
"nombre" => "F.M."
"apellidos" => "Rodríguez Santiago"
]
7 => array:2 [
"nombre" => "N."
"apellidos" => "Vicente Ibarra"
]
8 => array:2 [
"nombre" => "M.A."
"apellidos" => "Quintanilla Tello"
]
9 => array:2 [
"nombre" => "E."
"apellidos" => "Castilla Cabanes"
]
10 => array:2 [
"nombre" => "L."
"apellidos" => "Fácila Rubio"
]
11 => array:2 [
"nombre" => "V."
"apellidos" => "Pallarés-Carratalá"
]
]
]
]
]
"idiomaDefecto" => "en"
"Traduccion" => array:1 [
"es" => array:9 [
"pii" => "S0014256519301535"
"doi" => "10.1016/j.rce.2019.05.007"
"estado" => "S300"
"subdocumento" => ""
"abierto" => array:3 [
"ES" => false
"ES2" => false
"LATM" => false
]
"gratuito" => false
"lecturas" => array:1 [
"total" => 0
]
"idiomaDefecto" => "es"
"EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301535?idApp=WRCEE"
]
]
"EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419302176?idApp=WRCEE"
"url" => "/22548874/0000022000000002/v1_202002180732/S2254887419302176/v1_202002180732/en/main.assets"
]
"en" => array:19 [
"idiomaDefecto" => true
"cabecera" => "<span class="elsevierStyleTextfn">Brief Original</span>"
"titulo" => "Haemophagocytic syndrome associated with infections: Not so uncommon"
"tieneTextoCompleto" => true
"paginas" => array:1 [
0 => array:2 [
"paginaInicial" => "109"
"paginaFinal" => "114"
]
]
"autores" => array:1 [
0 => array:4 [
"autoresLista" => "F.F. Rodríguez Vidigal, A. Calvo Cano, M. Sánchez Sánchez, N. Nogales Muñoz, A. Vera Tomé, A. Muñoz Sanz"
"autores" => array:6 [
0 => array:2 [
"nombre" => "F.F."
"apellidos" => "Rodríguez Vidigal"
]
1 => array:2 [
"nombre" => "A."
"apellidos" => "Calvo Cano"
]
2 => array:2 [
"nombre" => "M."
"apellidos" => "Sánchez Sánchez"
]
3 => array:2 [
"nombre" => "N."
"apellidos" => "Nogales Muñoz"
]
4 => array:2 [
"nombre" => "A."
"apellidos" => "Vera Tomé"
]
5 => array:4 [
"nombre" => "A."
"apellidos" => "Muñoz Sanz"
"email" => array:1 [
0 => "oyacoi@unex.es"
]
"referencia" => array:1 [
0 => array:2 [
"etiqueta" => "<span class="elsevierStyleSup">*</span>"
"identificador" => "cor0005"
]
]
]
]
"afiliaciones" => array:1 [
0 => array:2 [
"entidad" => "Servicio de Patología Infecciosa, Hospital Universitario de Badajoz, Universidad de Extremadura, Badajoz, Spain"
"identificador" => "aff0005"
]
]
"correspondencia" => array:1 [
0 => array:3 [
"identificador" => "cor0005"
"etiqueta" => "⁎"
"correspondencia" => "Corresponding author."
]
]
]
]
"titulosAlternativos" => array:1 [
"es" => array:1 [
"titulo" => "Síndrome hemofagocítico asociado a infecciones: no tan infrecuente"
]
]
"textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hemophagocytic syndrome (HPS) or hemophagocytic lymphohistiocytosis is an immunological disorder characterized by the uncontrolled activity of the histiocyte system, expressed as systemic inflammation and hypercytokinemia, which can lead to progressive multiple organ failure.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> There is a primary pediatric form caused by genetic mutations that alter the function of cytotoxic NK and T cells or by inherited immunodeficiencies.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> In the secondary adult form, there is immune dysregulation (immunosuppression, lymphoma, solid neoplasm, autoimmune disease, human immunodeficiency virus infection [HIV]), in addition to a trigger (an infection or drug).<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1–4</span></a> Diagnosing HPS requires meeting 5 of the following criteria<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a>: fever, splenomegaly, bicytopenia, hypertriglyceridemia or hypofibrinogenemia, hemophagocytosis, hyperferritinemia, low NK-cell activity and increased soluble CD25 levels. HPS is an uncommon disorder, although it can be underdiagnosed.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> The incidence rate of HPS varies, with 1 case per 800,000 inhabitants/year in Japan and 0.9% in Sweden, and is associated with neoplasia in adults.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4,6,7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most common disorders associated with HPS are infections (41–49%), neoplasia (27–39%), autoimmune diseases (7–10%) and immunodeficiencies (6%).<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1,4</span></a> A number of virus triggers have been reported, including cytomegalovirus, Epstein–Barr virus (EBV), parvovirus B19 and the influenza virus. HPS can also be triggered by bacteria (<span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>, nontuberculous mycobacteria, <span class="elsevierStyleItalic">Staphylococcus aureus</span>, <span class="elsevierStyleItalic">Escherichia coli</span>), protozoa (<span class="elsevierStyleItalic">Leishmania</span> spp., <span class="elsevierStyleItalic">Toxoplasma gondii</span>, <span class="elsevierStyleItalic">Plasmodium</span> spp.) and fungi (<span class="elsevierStyleItalic">Pneumocystis jiroveci</span>, <span class="elsevierStyleItalic">Histoplasma capsulatum</span>).<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1,4,8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">HPS associated with infections is usually a severe condition that can be fatal without treatment. The prognosis depends on an early diagnosis and application of therapy against the triggering microorganism, as well as glucocorticoids and etoposide.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3,5,10</span></a> The incidence of HPS appears to have increased over the past decade,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> with obvious differences in its geographical distribution.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Due to the diagnosis of 6 cases of HPS associated with infections in recent years, it has been proposed that the local incidence rate of HPS is higher than expected. The aim of the study is to report our experience, estimate the minimum incidence rate in the health area and compare it with that published in the literature.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted an observational retrospective study of cases of HPS associated with infections, in patients older than 14 years, treated in the Department of Infectious Diseases of a university hospital within a 5-year period (2013–2017). We recorded the demographic data, disease history, previous immunosuppressants and glucocorticoids, clinical-laboratory data (assessment of the 2004 hemophagocytic lymphohistiocytosis criteria),<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> triggering infection (blood cultures, search for infection by <span class="elsevierStyleItalic">M. tuberculosis</span>, HIV, EBV, cytomegalovirus and <span class="elsevierStyleItalic">Leishmania</span> spp.), treatments and outcomes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To estimate the incidence rate in the health area, we performed an active search in the minimum basic data set of the Department of Admissions and obtained the number of area inhabitants (2015 data from the Spanish National Statistics Institute, municipal census of the 1st of January 2015).</p><p id="par0030" class="elsevierStylePara elsevierViewall">We reviewed the main series of HPS associated with infections in Europe, published during 2013–2017 (PubMed, keywords: hemophagocytic syndrome, hemophagocytic lymphohistiocytosis, infection, adult, Spain, or Europe).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The most relevant data for the 6 patients diagnosed in our department are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>; cases 4 and 5 are presented in greater detail.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Case 4. A 23-year-old woman was admitted in April 2015 for fever (39<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span>) that started 13 days earlier, accompanied by abdominal pain and oral thrush. The patient had a history of epilepsy in 2008 (treated with levetiracetam) and Crohn's disease in 2010 (treated with azathioprine). Her body mass index was 17.6<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, and her systolic blood pressure was 95<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg. Her complete blood count indicated pancytopenia (hemoglobin, 9.3<span class="elsevierStyleHsp" style=""></span>g/dL; leukocytes, 1500/mm<span class="elsevierStyleSup">3</span>; platelets, 11,900/mm<span class="elsevierStyleSup">3</span>). Biochemistry indicated a lactate dehydrogenase level of 1802<span class="elsevierStyleHsp" style=""></span>U/L, a glutamic oxaloacetic transaminase level of 210<span class="elsevierStyleHsp" style=""></span>U/L and a ferritin level of 4098<span class="elsevierStyleHsp" style=""></span>ng/mL. The cytomegalovirus viral load (VL) measured by polymerase chain reaction (PCR) in blood was 36,900<span class="elsevierStyleHsp" style=""></span>copies/mL, with a negative EBV VL. The patient was treated with ganciclovir. The bone marrow (BM) aspirate revealed hemophagocytosis. The patient was treated with dexamethasone (10<span class="elsevierStyleHsp" style=""></span>mg/day for the first 2 weeks and then a decreasing regimen). Crohn's disease activity was observed (computed tomography and gallium-67 indicating signs of ileitis and ascites). The patient was discharged from hospital with a prescription of valganciclovir and dexamethasone. At 1 month, the patient was asymptomatic and afebrile and had recovered weight.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Case 5. A 69-year-old man, after presenting febricula and asthenia for 2 weeks, began to experience afternoon fever (40<span class="elsevierStyleHsp" style=""></span>°C) and chills. The patient had a history of ischemic heart disease, carotid stenosis, chronic renal failure and IgA kappa multiple myeloma (treated with bortezomib and dexamethasone) in remission. The patient was awaiting autogenous transplantation. The patient had contact with dogs, pigs and chickens. During the examination, ecchymosis was detected in the legs, as well as splenomegaly. The complete blood count revealed the following: Hemoglobin, 9.5<span class="elsevierStyleHsp" style=""></span>g/dL; leukocytes, 700/mm<span class="elsevierStyleSup">3</span>; platelets, 33,000/mm<span class="elsevierStyleSup">3</span>. His biochemistry revealed the following: creatinine, 1.63<span class="elsevierStyleHsp" style=""></span>mg/dL; ferritin, 4581<span class="elsevierStyleHsp" style=""></span>ng/mL; gamma-glutamyl transferase, 234<span class="elsevierStyleHsp" style=""></span>U/L; triglycerides, 439<span class="elsevierStyleHsp" style=""></span>mg/dL. The patient's serum was positive for <span class="elsevierStyleItalic">Leishmania</span>-specific IgG at a titer of 1:40 (indirect immunofluorescence). The blood cultures were negative. Hemophagocytes were observed in the bone marrow aspirate, and the polymerase chain reaction was positive for <span class="elsevierStyleItalic">Leishmania</span> and negative for EBV, cytomegalovirus and <span class="elsevierStyleItalic">M. tuberculosis</span>. Despite undergoing therapy with liposomal amphotericin B, dexamethasone, etoposide and cyclosporine, the patient developed refractory pancytopenia, persistent fever and multiple organ failure, ultimately dying during the third week of hospitalization.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition to the 6 profiled cases, during 2013–2017, the hospital's minimum basic data set only recorded 2 more cases of HPS associated with infection: an adult with cytomegalovirus infection and a child with visceral leishmaniosis. For a population of 273,977 inhabitants in the covered health area, we calculated an incidence rate of HPS associated with infections of 1 case per 171,000 inhabitants/year (0.58 case per 100,000 inhabitants/year), including children and adults. During the last 5 years, 5 European series of HPS associated with infections in adults have been published, especially in Mediterranean countries (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>): a retrospective multicenter series,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> 2 retrospective series in a single center,<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11,12</span></a> a literature review of patients who underwent biologic therapies<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> and a multicenter search along with a literature review of patients (adults and children) with primary immunodeficiencies.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> In total, 75 adults with HPS were reported, with 30 deaths (40%). The microorganisms most often reported were cytomegalovirus (24/32.0%), EBV (18/24.0%), <span class="elsevierStyleItalic">M. tuberculosis</span> (15/20%), pyogenic bacteria (11/14.7%) and <span class="elsevierStyleItalic">Leishmania</span> spp. (10/13.3%).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The cases recorded in our health area estimate a minimum incidence rate for HPS associated with infection of 0.58 cases per 100,000 inhabitants/year, a rate higher than that reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Cases of HPS are probably increasing due to the increased survival of patients with hematological neoplasia and the increased use of immunosuppressive therapies. It is worth considering the possibility of underdiagnosis of HPS associated with infection, which could be due to the fact that only the underlying disease is recorded when HPS is the terminal event.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Our short series offers expected data in terms of the number of deaths (a third) and the predisposing conditions (neoplasia, Crohn's disease). There was a notable presence of <span class="elsevierStyleItalic">Leishmania</span> spp., with no epidemic outbreak such as the one related to several cases in Madrid.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> The prevalence of visceral leishmaniosis in the Mediterranean region is known.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> In our case, we can add the fact that half of the area's population live in rural settings. Visceral leishmaniosis usually causes fever, splenomegaly and bicytopenia, 3 criteria of HPS; we only have to add hyperferritinemia as the acute-phase reactant and hypertriglyceridemia to meet 5 of the current diagnostic criteria. In Greece, 1 of every 6 cases of visceral leishmaniosis progresses with HPS.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> We have found no cases associated with EBV, despite its role in the literature,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> probably because those cases are more common in children and in patients with lymphomas.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> European series of HPS associated with infections in adults that have been published in recent years show considerable heterogeneity in the etiologies and patients. We can extract as a general trend from these series that, when there is an abundance of patients with HIV infection<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> or patients who have been treated with biological agents,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> more infections by opportunistic microorganisms (mycobacteria, fungi, <span class="elsevierStyleItalic">T. gondii</span> and cytomegalovirus) will be reported. When lymphoproliferative syndromes predominate, the proportion of EBV infection cases increases.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">HPS associated with infections presents elements in common with the so-called immune reconstitution inflammatory syndrome: the shared pathogenic mechanisms and tissue damage caused by the inflammatory response exacerbates to a greater degree than the direct effects of the microorganism. In patients with HIV infection, HPS has been reported as a form of immune reconstitution.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Both disorders warn of the importance of adopting a damage–response perspective of the microbial pathogenesis, especially in immunosuppressed patients.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The participation of cytomegalovirus as a trigger of HPS in patients with Crohn's disease has been reported,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> and treatment with azathioprine has been proposed as a cofactor<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a>; however, in case 4 of our series, the HPS responded with the need to discontinue this drug (maintained to prevent a greater inflammatory response due to immune reconstitution).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Within the limitations inherent in the retrospective nature of the study and the shortened study period, we can conclude that HPS associated with infections can be more frequent than reported (in any case, the condition is not exceptional). The diagnostic suspicion is important, and the etiological investigation needs to consider the underlying disease and the geographical area's local epidemiology. In our setting, we propose an active search for <span class="elsevierStyleItalic">Leishmania</span> spp.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>"
"textoCompletoSecciones" => array:1 [
"secciones" => array:10 [
0 => array:3 [
"identificador" => "xres1309611"
"titulo" => "Abstract"
"secciones" => array:4 [
0 => array:2 [
"identificador" => "abst0005"
"titulo" => "Background"
]
1 => array:2 [
"identificador" => "abst0010"
"titulo" => "Material and method"
]
2 => array:2 [
"identificador" => "abst0015"
"titulo" => "Results"
]
3 => array:2 [
"identificador" => "abst0020"
"titulo" => "Conclusions"
]
]
]
1 => array:2 [
"identificador" => "xpalclavsec1209181"
"titulo" => "Keywords"
]
2 => array:3 [
"identificador" => "xres1309610"
"titulo" => "Resumen"
"secciones" => array:4 [
0 => array:2 [
"identificador" => "abst0025"
"titulo" => "Introducción"
]
1 => array:2 [
"identificador" => "abst0030"
"titulo" => "Material y método"
]
2 => array:2 [
"identificador" => "abst0035"
"titulo" => "Resultados"
]
3 => array:2 [
"identificador" => "abst0040"
"titulo" => "Conclusiones"
]
]
]
3 => array:2 [
"identificador" => "xpalclavsec1209180"
"titulo" => "Palabras clave"
]
4 => array:2 [
"identificador" => "sec0005"
"titulo" => "Background"
]
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" => "2018-11-26"
"fechaAceptado" => "2019-04-10"
"PalabrasClave" => array:2 [
"en" => array:1 [
0 => array:4 [
"clase" => "keyword"
"titulo" => "Keywords"
"identificador" => "xpalclavsec1209181"
"palabras" => array:6 [
0 => "Haemophagocytic syndrome"
1 => "Haemophagocytic lymphohistiocytosis"
2 => "Infection"
3 => "Cytomegalovirus"
4 => "<span class="elsevierStyleItalic">Leishmania</span>"
5 => "Trigger"
]
]
]
"es" => array:1 [
0 => array:4 [
"clase" => "keyword"
"titulo" => "Palabras clave"
"identificador" => "xpalclavsec1209180"
"palabras" => array:6 [
0 => "Síndrome hemofagocítico"
1 => "Linfohistiocitosis hemofagocítica"
2 => "Infección"
3 => "Citomegalovirus"
4 => "<span class="elsevierStyleItalic">Leishmania</span>"
5 => "Desencadenante"
]
]
]
]
"tieneResumen" => true
"resumen" => array:2 [
"en" => array:3 [
"titulo" => "Abstract"
"resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Haemophagocytic syndrome (HPS) is a severe immunological disorder characterized by uncontrolled inflammation and multiple organ failure. HPS can be triggered by viral, bacterial, fungal and parasitical infections. We report our experience with infection-related HPS and estimate its local incidence.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted an observational retrospective study of infection-associated HPS in patients treated in the Department of Infectious Diseases of a university hospital within a 5-year period, as well as a review of the published series in Europe.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">HPS was associated with infection by cytomegalovirus in 2 women with Crohn's disease and was associated with visceral leishmaniosis in 4 patients (3 men, 1 woman; 1 case of multiple myeloma; 2 cases of solid tumors; 1 case of no apparent disease). Two patients died, and the estimated incidence rate was 0.58/100,000 inhabitants/year. The published series are mixed.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Infection-related HPS must be more common than reported. The geographical environment can influence the triggering infections (in our environment, <span class="elsevierStyleItalic">Leishmania</span> should be considered).</p></span>"
"secciones" => array:4 [
0 => array:2 [
"identificador" => "abst0005"
"titulo" => "Background"
]
1 => array:2 [
"identificador" => "abst0010"
"titulo" => "Material and method"
]
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">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El síndrome hemofagocítico (SHF) es un trastorno inmunológico grave caracterizado por una inflamación descontrolada con fracaso multiorgánico. Puede estar desencadenado por infecciones víricas, bacterianas, fúngicas o parasitarias. Se describe nuestra experiencia de SHF asociado a infecciones y se estima su incidencia local.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo observacional de SHF asociado a infecciones en adultos atendidos en el Servicio de Patología Infecciosa de un hospital universitario durante 5<span class="elsevierStyleHsp" style=""></span>años y revisión de las series publicadas en Europa.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En 2<span class="elsevierStyleHsp" style=""></span>mujeres con enfermedad de Crohn, el SHF se asoció a infección por citomegalovirus y a leishmaniosis visceral (mieloma múltiple 1, tumor sólido 2, sin enfermedad evidente 1) en 4<span class="elsevierStyleHsp" style=""></span>pacientes (3 hombres). Fallecieron 2<span class="elsevierStyleHsp" style=""></span>enfermos. La incidencia estimada fue 0,58/100.000/año. Las series publicadas son heterogéneas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El SHF asociado a infecciones debe de ser más frecuente de lo descrito. El entorno geográfico puede influir en las infecciones desencadenantes (en nuestro medio, debe buscarse <span class="elsevierStyleItalic">Leishmania).</span></p></span>"
"secciones" => array:4 [
0 => array:2 [
"identificador" => "abst0025"
"titulo" => "Introducción"
]
1 => array:2 [
"identificador" => "abst0030"
"titulo" => "Material y método"
]
2 => array:2 [
"identificador" => "abst0035"
"titulo" => "Resultados"
]
3 => array:2 [
"identificador" => "abst0040"
"titulo" => "Conclusiones"
]
]
]
]
"NotaPie" => array:1 [
0 => array:2 [
"etiqueta" => "☆"
"nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Rodríguez Vidigal FF, Calvo Cano A, Sánchez Sánchez M, Nogales Muñoz N, Vera Tomé A, Muñoz Sanz A. Síndrome hemofagocítico asociado a infecciones: no tan infrecuente. Rev Clin Esp. 2020;220:109–114.</p>"
]
]
"multimedia" => array:2 [
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 [
"leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: BM, bone marrow; CMV, cytomegalovirus; Hb, hemoglobin; LAB, liposomal amphotericin B; PCR, polymerase chain reaction.</p>"
"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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Year/case \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2013/1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2014/2 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2014/3 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2015/4 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2017/5 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2017/6 \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Age/sex \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">66/F \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">68/F \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">66/M \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">23/F \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">69/M \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">71/M \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Predisposing condition \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Crohn's disease \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Endometrial adenocarcinoma \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">– \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Crohn's disease \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Multiple myeloma \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Urothelial carcinoma \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Previous treatments \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Azathioprine, prednisone, infliximab \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Chemotherapy \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">– \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Azathioprine \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Bortezomib, dexamethasone \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">– \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Symptoms \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Fever \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Fever and splenomegaly \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Fever and splenomegaly \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Fever \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Fever and splenomegaly \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Fever and splenomegaly \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Complete blood count \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hb 10.1<span class="elsevierStyleHsp" style=""></span>g/dL, neutrophils 800/mm<span class="elsevierStyleSup">3</span>, platelets 45,000/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hb 8.1<span class="elsevierStyleHsp" style=""></span>g/dL, leukocytes 900/mm<span class="elsevierStyleSup">3</span>, platelets 18,000/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hb 8.4<span class="elsevierStyleHsp" style=""></span>g/dL, leukocytes 1900/mm<span class="elsevierStyleSup">3</span>, platelets 63,000/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hb 9.3<span class="elsevierStyleHsp" style=""></span>g/dL, leukocytes 1500/mm<span class="elsevierStyleSup">3</span>, platelets 11,900/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hb 9.5<span class="elsevierStyleHsp" style=""></span>g/dL, leukocytes 700/mm<span class="elsevierStyleSup">3</span>, platelets 33,000/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hb 7.3<span class="elsevierStyleHsp" style=""></span>g/dL, leukocytes 400/mm<span class="elsevierStyleSup">3</span>, platelets 36,000/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Fibrinogen \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">92<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><100<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Normal \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Normal \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">168<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">150<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Triglycerides \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">364<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">521<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">350<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">405<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">439<span class="elsevierStyleHsp" style=""></span>mg/dL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Normal \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Ferritin \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">51,020<span class="elsevierStyleHsp" style=""></span>ng/mL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">7000<span class="elsevierStyleHsp" style=""></span>ng/mL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">9400<span class="elsevierStyleHsp" style=""></span>ng/mL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4098<span class="elsevierStyleHsp" style=""></span>ng/mL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4581<span class="elsevierStyleHsp" style=""></span>ng/mL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">37,940<span class="elsevierStyleHsp" style=""></span>ng/mL \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">CD4+ lymphocytes \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">857/μL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">81/μL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">263/μL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">198/μL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">80/μL \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">– \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">BM \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hemophagocytes \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">– \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hemophagocytes \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hemophagocytes \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hemophagocytes \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hemophagocytes \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">InfectionDiagnosis \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">CMVBlood PCR \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Visceral leishmaniosisSerology \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Visceral leishmaniosisPCR in BM \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">CMVBlood and BM PCR \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Visceral leishmaniosisPCR in BM \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Visceral leishmaniosisPCR in BM \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Treatment \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Valganciclovir, dexamethasone etoposide, flebogamma, fibrinogen \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">LAB, dexamethasone \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">LAB, dexamethasone, cyclosporine \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Ganciclovir, dexamethasone \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">LAB, dexamethasone, etoposide, cyclosporine \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">LAB, dexamethasone etoposide, cyclosporin \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Outcome \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Death \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Good \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Good \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Good \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Death \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Good \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
]
"imagenFichero" => array:1 [
0 => "xTab2244417.png"
]
]
]
]
"descripcion" => array:1 [
"en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hemophagocytic syndrome associated with infections.</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"
]
]
"tabla" => array:3 [
"leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CMV, cytomegalovirus; EBMT, European Society of Blood and Marrow Transplantation; EBV, Epstein–Barr virus; HHV-8, human herpesvirus 8; HIV, human immunodeficiency virus; HPS, hemophagocytic syndrome; HSV, herpes simplex virus; Leish, Leishmania; LPS, lymphoproliferative syndrome (including T-cell, B-cell and NK-cell lymphomas, chronic lymphocytic leukemia, primary cerebral lymphoma and Castleman disease); NTM, nontuberculous mycobacteria; PID, primary immunodeficiencies; TB, tuberculosis; TNF, tumor necrosis factor.</p>"
"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="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">First author and year \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country,centers,years \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of infections/total HPS \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">CMV \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Leish \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">EBV \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other infections \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Underlying disease \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">DeathsFactors \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Bode et al., 2015<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Europe (EBMT)HPS in PID<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Multicenter and literature review before 2014 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">6/63 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">– \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleItalic">Burkholderia cepacia</span> 1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">PID all \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2 (33%) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Hernández-Jiménez et al., 2016<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Spain, HPSOne center2010–2015 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">6/18 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">LPS 7Other neoplasia 1Autoimmune 1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1 (17%)Neoplasias 6/8 67% \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Brito-Zerón et al., 2016<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Literature review HPS, in patients treated with biological agents1996–2013 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">20/30 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">TB 5Histoplasmosis 3<span class="elsevierStyleItalic">Escherichia coli</span> 2<span class="elsevierStyleItalic">Staphylococcus aureus</span> 1Brucellosis 1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Autoimmune 24LPS 6Anti-TNF 19 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">4 (20%)TB 60%>65 years 62% \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Lerolle et al., 2016<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">France, HPSThree centers2006–2011 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">38 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">11 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">TB 10Pyogenic 7Toxoplasmosis 4NTM 3Malaria 3HHV-8 2HSV 2 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">HIV 19Other immunosuppression 12 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">12 (32%)All immunosuppressed \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Cattaneo et al., 2017<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Italy, HPSOne center2004–2014 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">25/35 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">8 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">– \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="char" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">10 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">HHV-8 6HIV 1 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">LPS 26Autoimmune 4 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">11 (44%) \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
]
"imagenFichero" => array:1 [
0 => "xTab2244418.png"
]
]
]
"notaPie" => array:1 [
0 => array:3 [
"identificador" => "tblfn0005"
"etiqueta" => "a"
"nota" => "<p class="elsevierStyleNotepara" id="npar0005">Including adults and children (only infections in adults are recorded).</p>"
]
]
]
"descripcion" => array:1 [
"en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">European series of infection-associated hemophagocytic syndrome in adults.</p>"
]
]
]
"bibliografia" => array:2 [
"titulo" => "References"
"seccion" => array:1 [
0 => array:2 [
"identificador" => "bibs0015"
"bibliografiaReferencia" => array:19 [
0 => array:3 [
"identificador" => "bib0100"
"etiqueta" => "1"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Adult haemophagocytic syndrome"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:5 [
0 => "M. Ramos-Casals"
1 => "P. Brito-Zerón"
2 => "A. López-Guillermo"
3 => "M.A. Khamashta"
4 => "X. Bosch"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1016/S0140-6736(13)61048-X"
"Revista" => array:6 [
"tituloSerie" => "Lancet"
"fecha" => "2014"
"volumen" => "383"
"paginaInicial" => "1503"
"paginaFinal" => "1516"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/24290661"
"web" => "Medline"
]
]
]
]
]
]
]
]
1 => array:3 [
"identificador" => "bib0105"
"etiqueta" => "2"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Hemophagocytic syndromes (HPSs) including hemophagocytic lymphohistiocytosis (HLH) in adults: a systematic scoping review"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:5 [
0 => "A. Hayden"
1 => "S. Park"
2 => "D. Giustini"
3 => "A.Y. Lee"
4 => "L.Y. Chen"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1016/j.blre.2016.05.001"
"Revista" => array:6 [
"tituloSerie" => "Blood Rev"
"fecha" => "2016"
"volumen" => "30"
"paginaInicial" => "411"
"paginaFinal" => "420"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/27238576"
"web" => "Medline"
]
]
]
]
]
]
]
]
2 => array:3 [
"identificador" => "bib0110"
"etiqueta" => "3"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Hereditary and acquired hemophagocytic lymphohistiocytosis"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:3 [
0 => "L. Zhang"
1 => "J. Zhou"
2 => "L. Sokol"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1177/107327481402100406"
"Revista" => array:6 [
"tituloSerie" => "Cancer Control"
"fecha" => "2014"
"volumen" => "21"
"paginaInicial" => "301"
"paginaFinal" => "312"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/25310211"
"web" => "Medline"
]
]
]
]
]
]
]
]
3 => array:3 [
"identificador" => "bib0115"
"etiqueta" => "4"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Hemophagocytic lymphohistiocytosis: review of etiologies and management"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:1 [
0 => "M.R. George"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.2147/JBM.S46255"
"Revista" => array:6 [
"tituloSerie" => "J Blood Med"
"fecha" => "2014"
"volumen" => "5"
"paginaInicial" => "69"
"paginaFinal" => "86"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/24966707"
"web" => "Medline"
]
]
]
]
]
]
]
]
4 => array:3 [
"identificador" => "bib0120"
"etiqueta" => "5"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "J.I. Henter"
1 => "A. Horne"
2 => "M. Arico"
3 => "R.M. Egeler"
4 => "A.H. Filipovich"
5 => "S. Imashuku"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1002/pbc.21039"
"Revista" => array:6 [
"tituloSerie" => "Pediatr Blood Cancer"
"fecha" => "2007"
"volumen" => "48"
"paginaInicial" => "124"
"paginaFinal" => "131"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/16937360"
"web" => "Medline"
]
]
]
]
]
]
]
]
5 => array:3 [
"identificador" => "bib0125"
"etiqueta" => "6"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Nationwide survey of hemophagocytic lymphohistiocytosis in Japan"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "E. Ishii"
1 => "S. Ohga"
2 => "S. Imashuku"
3 => "M. Yasukawa"
4 => "H. Tsuda"
5 => "I. Miura"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1532/IJH97.07012"
"Revista" => array:6 [
"tituloSerie" => "Int J Hematol"
"fecha" => "2007"
"volumen" => "86"
"paginaInicial" => "58"
"paginaFinal" => "65"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/17675268"
"web" => "Medline"
]
]
]
]
]
]
]
]
6 => array:3 [
"identificador" => "bib0130"
"etiqueta" => "7"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Malignancy-associated hemophagocytic lymphohistiocytosis in adults: a retrospective population-based analysis from a single center"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:4 [
0 => "M. Machaczka"
1 => "J. Vaktnas"
2 => "M. Klimkowska"
3 => "H. Hagglund"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.3109/10428194.2010.551153"
"Revista" => array:6 [
"tituloSerie" => "Leuk Lymphoma"
"fecha" => "2011"
"volumen" => "52"
"paginaInicial" => "613"
"paginaFinal" => "619"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/21299462"
"web" => "Medline"
]
]
]
]
]
]
]
]
7 => array:3 [
"identificador" => "bib0135"
"etiqueta" => "8"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Diversity and combinations of infectious agents in 38 adults with an infection-triggered reactive haemophagocytic syndrome: a multicenter study"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "N. Lerolle"
1 => "M. Laanani"
2 => "S. Rivière"
3 => "L. Galicier"
4 => "P. Coppo"
5 => "J.L. Meynard"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1016/j.cmi.2015.11.018"
"Revista" => array:5 [
"tituloSerie" => "Clin Microbiol Infect"
"fecha" => "2016"
"volumen" => "22"
"paginaInicial" => "268"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/26686809"
"web" => "Medline"
]
]
]
]
]
]
]
]
8 => array:3 [
"identificador" => "bib0140"
"etiqueta" => "9"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Infection is the major trigger of hemophagocytic syndrome in adult patients treated with biological therapies"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "P. Brito-Zerón"
1 => "X. Bosch"
2 => "M. Pérez-de-Lis"
3 => "R. Pérez-Álvarez"
4 => "G. Fraile"
5 => "H. Gheitasi"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1016/j.semarthrit.2015.07.004"
"Revista" => array:6 [
"tituloSerie" => "Semin Arthritis Rheum"
"fecha" => "2016"
"volumen" => "45"
"paginaInicial" => "391"
"paginaFinal" => "399"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/26277577"
"web" => "Medline"
]
]
]
]
]
]
]
]
9 => array:3 [
"identificador" => "bib0145"
"etiqueta" => "10"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "How I treat hemophagocytic lymphohistiocytosis in the adult patient"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:2 [
0 => "A.M. Schram"
1 => "N. Berliner"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1182/blood-2015-01-551622"
"Revista" => array:6 [
"tituloSerie" => "Blood"
"fecha" => "2015"
"volumen" => "125"
"paginaInicial" => "2908"
"paginaFinal" => "2914"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/25758828"
"web" => "Medline"
]
]
]
]
]
]
]
]
10 => array:3 [
"identificador" => "bib0150"
"etiqueta" => "11"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Hemophagocytic lymphohistiocytosis: analysis of 18 cases"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:6 [
0 => "P. Hernández-Jiménez"
1 => "C. Díaz-Pedroche"
2 => "J. Laureiro"
3 => "O. Madrid"
4 => "E. Martín"
5 => "C. Lumbreras"
]
]
]
]
]
"host" => array:1 [
0 => array:1 [
"Revista" => array:5 [
"tituloSerie" => "Med Clin (Barc)"
"fecha" => "2016"
"volumen" => "147"
"paginaInicial" => "495"
"paginaFinal" => "498"
]
]
]
]
]
]
11 => array:3 [
"identificador" => "bib0155"
"etiqueta" => "12"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Adult onset hemophagocytic lymphohistiocytosis prognosis is affected by underlying disease and coexisting viral infection: analysis of a single institution series of 35 patients"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "C. Cattaneo"
1 => "M. Oberti"
2 => "C. Skert"
3 => "A. Passi"
4 => "M. Farina"
5 => "A. Re"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1002/hon.2314"
"Revista" => array:6 [
"tituloSerie" => "Hematol Oncol"
"fecha" => "2017"
"volumen" => "35"
"paginaInicial" => "828"
"paginaFinal" => "883"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/27255829"
"web" => "Medline"
]
]
]
]
]
]
]
]
12 => array:3 [
"identificador" => "bib0160"
"etiqueta" => "13"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "The syndrome of hemophagocytic lymphohistiocytosis in primary immunodeficiencies: implications for differential diagnosis and pathogenesis"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "S.F. Bode"
1 => "S. Ammann"
2 => "W. Al-Herz"
3 => "M. Bataneant"
4 => "C.C. Dvorak"
5 => "S. Gehring"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.3324/haematol.2014.121608"
"Revista" => array:6 [
"tituloSerie" => "Haematologica"
"fecha" => "2015"
"volumen" => "100"
"paginaInicial" => "978"
"paginaFinal" => "988"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/26022711"
"web" => "Medline"
]
]
]
]
]
]
]
]
13 => array:3 [
"identificador" => "bib0165"
"etiqueta" => "14"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Visceral leishmaniasis: an update"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:2 [
0 => "B. Faucher"
1 => "R. Piarroux"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1016/j.revmed.2010.08.002"
"Revista" => array:6 [
"tituloSerie" => "Rev Med Interne"
"fecha" => "2011"
"volumen" => "32"
"paginaInicial" => "544"
"paginaFinal" => "551"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/20850210"
"web" => "Medline"
]
]
]
]
]
]
]
]
14 => array:3 [
"identificador" => "bib0170"
"etiqueta" => "15"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Current clinical, laboratory, and treatment outcome characteristics of visceral leishmaniasis: results from a seven-year retrospective study in Greece"
"autores" => array:1 [
0 => array:2 [
"etal" => true
"autores" => array:6 [
0 => "S.P. Georgiadou"
1 => "A. Stefos"
2 => "G. Spanakos"
3 => "S. Skrimpas"
4 => "K. Makaritsis"
5 => "N.V. Sipsas"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1016/j.ijid.2015.02.021"
"Revista" => array:6 [
"tituloSerie" => "Int J Infect Dis"
"fecha" => "2015"
"volumen" => "34"
"paginaInicial" => "46"
"paginaFinal" => "50"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/25743761"
"web" => "Medline"
]
]
]
]
]
]
]
]
15 => array:3 [
"identificador" => "bib0175"
"etiqueta" => "16"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Linfohistiocitosis hemofagocítica asociada a infecciones virales: reto diagnóstico y dilema terapéutico"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:4 [
0 => "J.L. Mostaza-Fernández"
1 => "J. Laso"
2 => "D. Carriedo Ule"
3 => "J.M.G. Ruiz de Morales"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1016/j.rce.2014.03.009"
"Revista" => array:6 [
"tituloSerie" => "Rev Clín Esp"
"fecha" => "2014"
"volumen" => "214"
"paginaInicial" => "320"
"paginaFinal" => "327"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/24796638"
"web" => "Medline"
]
]
]
]
]
]
]
]
16 => array:3 [
"identificador" => "bib0180"
"etiqueta" => "17"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Immune reconstitution visceral leishmaniasis presented as hemophagocytic syndrome in a patient with AIDS from a nonendemic area: a case report"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:5 [
0 => "K.K. Patel"
1 => "A.K. Patel"
2 => "P. Sarda"
3 => "B.A. Shah"
4 => "R. Ranjan"
]
]
]
]
]
"host" => array:1 [
0 => array:1 [
"Revista" => array:5 [
"tituloSerie" => "J Int Assoc Phys AIDS Care"
"fecha" => "2009"
"volumen" => "8"
"paginaInicial" => "217"
"paginaFinal" => "220"
]
]
]
]
]
]
17 => array:3 [
"identificador" => "bib0185"
"etiqueta" => "18"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "The damage–response framework of microbial pathogenesis"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:2 [
0 => "A. Casadevall"
1 => "L.A. Pirofski"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1038/nrmicro732"
"Revista" => array:6 [
"tituloSerie" => "Nat Rev Microbiol"
"fecha" => "2003"
"volumen" => "1"
"paginaInicial" => "17"
"paginaFinal" => "24"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/15040176"
"web" => "Medline"
]
]
]
]
]
]
]
]
18 => array:3 [
"identificador" => "bib0190"
"etiqueta" => "19"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Cytomegalovirus-associated hemophagocytic syndrome in a child with Crohn disease receiving azathioprine"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:5 [
0 => "T.G. Lokesh Babu"
1 => "D. Boctor"
2 => "A. Davey"
3 => "M.C. Bond"
4 => "K. Jacobson"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1097/00005176-200410000-00020"
"Revista" => array:6 [
"tituloSerie" => "J Pediatr Gastroenterol Nutr"
"fecha" => "2004"
"volumen" => "39"
"paginaInicial" => "418"
"paginaFinal" => "421"
"link" => array:1 [
0 => array:2 [
"url" => "https://www.ncbi.nlm.nih.gov/pubmed/15448434"
"web" => "Medline"
]
]
]
]
]
]
]
]
]
]
]
]
]
"idiomaDefecto" => "en"
"url" => "/22548874/0000022000000002/v1_202002180732/S2254887419301298/v1_202002180732/en/main.assets"
"Apartado" => array:4 [
"identificador" => "1903"
"tipo" => "SECCION"
"en" => array:2 [
"titulo" => "Brief Original"
"idiomaDefecto" => true
]
"idiomaDefecto" => "en"
]
"PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000002/v1_202002180732/S2254887419301298/v1_202002180732/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
"EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301298?idApp=WRCEE"
]
