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con evidentes diferencias en la distribuci&#243;n geogr&#225;fica<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a>&#46; Debido al diagn&#243;stico de 6<span class="elsevierStyleHsp" style=""></span>casos de SHF asociado a infecciones durante los &#250;ltimos a&#241;os&#44; se plantea que su incidencia local puede ser mayor de lo esperable&#46; El objetivo del trabajo es describir nuestra experiencia&#44; estimar la incidencia m&#237;nima en el &#225;rea de salud y compararla con lo publicado en la literatura&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Estudio observacional retrospectivo de los casos de SHF asociado a infecciones&#44; en sujetos mayores de 14 a&#241;os&#44; atendidos en el Servicio de Patolog&#237;a Infecciosa de un hospital universitario durante 5<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;2013-2017&#41;&#46; Se registraron los datos de filiaci&#243;n&#44; antecedentes patol&#243;gicos&#44; inmunosupresores o glucocorticoides previos&#44; datos cl&#237;nico-anal&#237;ticos &#40;valoraci&#243;n de los criterios HLH-2004&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a>&#44; infecci&#243;n desencadenante &#40;hemocultivos&#44; b&#250;squeda de infecci&#243;n por <span class="elsevierStyleItalic">M&#46; tuberculosis</span>&#44; VIH&#44; VEB&#44; CMV y <span class="elsevierStyleItalic">Leishmania</span> spp&#46;&#41;&#44; tratamiento y evoluci&#243;n&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para estimar la incidencia en el &#225;rea de salud&#44; se efectu&#243; una b&#250;squeda activa en el CMBD del Servicio de Admisi&#243;n y se obtuvo el n&#250;mero de habitantes del &#225;rea &#40;datos del INE 2015&#44; padr&#243;n municipal a 1 de enero del 2015&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se revisaron las principales series de SHF asociado a infecciones en Europa&#44; publicadas durante los a&#241;os 2013 a 2017 &#40;Pubmed&#44; <span class="elsevierStyleItalic">keywords&#58; hemophagocytic syndrome&#44; hemophagocytic lymphohistiocytosis&#44; infection&#44; adult&#44; Spain&#44; or Europe&#41;&#46;</span></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Los datos m&#225;s relevantes de los 6<span class="elsevierStyleHsp" style=""></span>pacientes diagnosticados en nuestro servicio se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> Se describen con mayor detalle los casos 4 y 5&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Caso 4&#46; Mujer de 23 a&#241;os ingresada en abril de 2015 por fiebre &#40;39<span class="elsevierStyleHsp" style=""></span>&#176;<span class="elsevierStyleSmallCaps">C</span>&#41; de 13 d&#237;as de evoluci&#243;n&#44; acompa&#241;ada de dolor abdominal y aftas orales&#46; Antecedentes de epilepsia en 2008 &#40;tratada con levetiracetam&#41; y de enfermedad de Crohn en 2010 &#40;tratada con azatioprina&#41;&#46; El &#237;ndice de masa corporal era de 17&#44;6<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> y la presi&#243;n arterial sist&#243;lica de 95<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Hemograma&#58; pancitopenia &#40;Hb 9&#44;3<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#59; leucocitos 1&#46;500&#47;mm<span class="elsevierStyleSup">3</span> y plaquetas 11&#46;900&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#46; Bioqu&#237;mica&#58; lactato deshidrogenasa 1&#46;802 U&#47;l&#44; transaminasa glut&#225;mico-oxalac&#233;tica 210 U&#47;l y ferritina 4&#46;098 ng&#47;ml&#46; Carga v&#237;rica &#40;CV&#41; por PCR de CMV en sangre&#58; 36&#46;900 copias&#47;ml&#46; CV de VEB negativa&#46; Fue tratada con ganciclovir&#46; En el aspirado de m&#233;dula &#243;sea &#40;MO&#41; se apreci&#243; hemofagocitosis&#46; Recibi&#243; tratamiento con dexametasona &#40;10<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a durante las primeras 2<span class="elsevierStyleHsp" style=""></span>semanas y pauta decreciente&#41;&#46; Se demostr&#243; actividad de la enfermedad de Crohn &#40;ascitis y datos de ile&#237;tis mediante tomograf&#237;a computarizada y galio-67&#41;&#46; Se dio el alta hospitalaria con valganciclovir y dexametasona&#46; Al mes&#44; estaba asintom&#225;tica y afebril&#44; y hab&#237;a recuperado peso&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Caso 5&#46; Var&#243;n de 69 a&#241;os de edad que&#44; tras presentar febr&#237;cula y astenia durante 2<span class="elsevierStyleHsp" style=""></span>semanas&#44; comenz&#243; con fiebre vespertina &#40;40<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; y escalofr&#237;os&#46; Antecedentes de cardiopat&#237;a isqu&#233;mica&#44; estenosis carot&#237;dea&#44; insuficiencia renal cr&#243;nica y mieloma m&#250;ltiple IgA <span class="elsevierStyleItalic">kappa</span> &#40;tratado con bortezomib y dexametasona&#41;&#44; en remisi&#243;n&#44; pendiente de trasplante aut&#243;geno&#46; Contacto con perros&#44; cerdos y gallinas&#46; En la exploraci&#243;n&#44; equimosis en miembros inferiores y esplenomegalia&#46; Hemograma&#58; Hb 9&#44;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; leucocitos 700&#47;mm<span class="elsevierStyleSup">3</span>&#44; plaquetas 33&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&#46; Bioqu&#237;mica&#58; creatinina 1&#44;63<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; ferritina 4&#46;581 ng&#47;ml&#44; gamma glutamil transpeptidasa 234 U&#47;l&#44; triglic&#233;ridos 439<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Serolog&#237;a <span class="elsevierStyleItalic">Leishmania</span> IgG positiva 1&#47;40 &#40;inmunofluorescencia indirecta&#41;&#46; Hemocultivos negativos&#46; En el aspirado de MO se observaron hemofagocitos y la PCR para <span class="elsevierStyleItalic">Leishmania</span> fue positiva y negativa para VEB&#44; CMV y <span class="elsevierStyleItalic">M&#46; tuberculosis</span>&#46; A pesar de recibir tratamiento con anfotericina B liposomal&#44; dexametasona&#44; etop&#243;sido y ciclosporina&#44; desarroll&#243; pancitopenia refractaria&#44; fiebre persistente&#44; fracaso multiorg&#225;nico y muerte en la tercera semana de ingreso&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Adem&#225;s de los 6<span class="elsevierStyleHsp" style=""></span>casos rese&#241;ados&#44; durante el per&#237;odo 2013-2017&#44; en el CMBD del hospital tan solo se recogieron 2<span class="elsevierStyleHsp" style=""></span>casos m&#225;s de SHF asociado a infecci&#243;n&#58; un adulto con infecci&#243;n por CMV y un ni&#241;o con leishmaniosis visceral&#46; Para una poblaci&#243;n de 273&#46;977 habitantes en el &#225;rea de salud atendida&#44; se calcul&#243; una incidencia estimada de SHF asociado a infecciones de 1&#47;171&#46;000 habitantes&#47;a&#241;o &#40;0&#44;58&#47;100&#46;000 habitantes&#47;a&#241;o&#41;&#44; incluyendo ni&#241;os y adultos&#46; Durante los &#250;ltimos 5<span class="elsevierStyleHsp" style=""></span>a&#241;os se han publicado 5<span class="elsevierStyleHsp" style=""></span>series europeas de SHF asociado a infecciones en adultos&#44; especialmente en pa&#237;ses de la cuenca mediterr&#225;nea &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#58; una serie retrospectiva multic&#233;ntrica<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a>&#44; 2<span class="elsevierStyleHsp" style=""></span>retrospectivas en un &#250;nico centro<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; una revisi&#243;n de la literatura en pacientes tratados mediante tratamientos biol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> y una b&#250;squeda multic&#233;ntrica junto con revisi&#243;n de la literatura en pacientes &#40;adultos y ni&#241;os&#41; con inmunodeficiencias primarias<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a>&#46; En total&#44; se describen 75 adultos con SHF&#44; con 30 fallecidos &#40;40&#37;&#41;&#46; Los microorganismos relacionados m&#225;s frecuentemente son CMV &#40;24&#47;32&#44;0&#37;&#41;&#44; VEB &#40;18&#47;24&#44;0&#37;&#41;&#44; <span class="elsevierStyleItalic">M&#46; tuberculosis</span> &#40;15&#47;20&#37;&#41;&#44; bacterias pi&#243;genas &#40;11&#47;14&#44;7&#37;&#41; y <span class="elsevierStyleItalic">Leishmania</span> spp&#46; &#40;10&#47;13&#44;3&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Los casos recogidos en nuestra &#225;rea de salud permiten estimar una incidencia m&#237;nima de SHF asociado a infecci&#243;n de 0&#44;58&#47;100&#46;000&#47;a&#241;o&#44; superior a la descrita en la literatura<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a>&#46; Probablemente&#44; los casos de SHF est&#225;n aumentando por la mayor supervivencia de los pacientes con neoplasias hematol&#243;gicas y por el incremento de los tratamientos inmunosupresores&#46; Cabe plantearse la posibilidad de un infradiagn&#243;stico del SHF asociado a infecci&#243;n&#44; que podr&#237;a explicarse porque solo se registra la enfermedad de base cuando el SHF es el evento terminal&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Nuestra corta serie ofrece datos esperables en cuanto al n&#250;mero de fallecidos &#40;la tercera parte&#41; y las situaciones predisponentes &#40;neoplasias&#44; enfermedad de Crohn&#41;&#46; Llama la atenci&#243;n la presencia de <span class="elsevierStyleItalic">Leishmania</span> spp&#46;&#44; sin un brote epid&#233;mico como el relacionado con varios casos en Madrid<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a>&#46; Es conocida la prevalencia de la leishmaniosis visceral en la cuenca mediterr&#225;nea<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> y&#44; en nuestro caso&#44; se suma el hecho de que la mitad de la poblaci&#243;n del &#225;rea vive en el &#225;mbito rural&#46; La leishmaniosis visceral suele ocasionar fiebre&#44; esplenomegalia y bicitopenia&#44; 3<span class="elsevierStyleHsp" style=""></span>criterios de SHF&#59; basta con a&#241;adir la hiperferritinemia como reactante de fase aguda e hipertrigliceridemia para cumplir 5<span class="elsevierStyleHsp" style=""></span>de los criterios diagn&#243;sticos vigentes&#46; En Grecia&#44; uno de cada 6<span class="elsevierStyleHsp" style=""></span>casos de leishmaniosis visceral cursa con SHF<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a>&#46; No hemos encontrado casos asociados al VEB&#44; a pesar de su protagonismo en la literatura<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a>&#44; probablemente porque son m&#225;s frecuentes en ni&#241;os y en pacientes con linfomas<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a>&#46; Las series europeas de SHF asociado a infecciones en adultos publicadas durante los &#250;ltimos a&#241;os muestran una gran heterogeneidad de etiolog&#237;as y de pacientes&#46; Se puede extraer&#44; como tendencia general de dichas series&#44; que&#44; cuando abundan pacientes infectados por el VIH<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> o tratados con agentes biol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a>&#44; se describen m&#225;s infecciones por microorganismos oportunistas &#40;micobacterias&#44; hongos&#44; <span class="elsevierStyleItalic">T&#46; gondii</span> y CMV&#41;&#59; por otro lado&#44; cuando predominan los s&#237;ndromes linfoproliferativos&#44; aumenta la proporci&#243;n de VEB<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El SHF asociado a infecciones presenta elementos en com&#250;n con el denominado s&#237;ndrome inflamatorio de reconstituci&#243;n inmune&#58; los mecanismos patog&#233;nicos compartidos y el da&#241;o tisular generado por la respuesta inflamatoria exacerbada m&#225;s que por efecto directo del microorganismo&#46; En pacientes con infecci&#243;n por el VIH se ha llegado a describir el SHF como una forma de reconstituci&#243;n inmune<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a>&#46; Ambos trastornos advierten de la importancia de adoptar una perspectiva da&#241;o-respuesta de la patog&#233;nesis microbiana&#44; especialmente en inmunodeprimidos<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Est&#225; descrita la participaci&#243;n del CMV como desencadenante del SHF en pacientes con enfermedad de Crohn<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> y se ha propuesto como cofactor el tratamiento con azatioprina<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a>&#59; sin embargo&#44; en el caso 4 de nuestra serie el SHF respondi&#243; sin necesidad de suspender dicho f&#225;rmaco &#40;mantenido para evitar una mayor respuesta inflamatoria por reconstituci&#243;n inmune&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Con las limitaciones propias del car&#225;cter retrospectivo y el recortado per&#237;odo&#44; se concluye que el SHF asociado a infecciones puede ser m&#225;s frecuente de lo descrito &#40;en todo caso&#44; no es excepcional&#41;&#46; Es importante la sospecha diagn&#243;stica y en la pesquisa etiol&#243;gica han de tenerse en cuenta la enfermedad subyacente y la epidemiolog&#237;a local de la zona geogr&#225;fica&#46; En nuestro medio&#44; proponemos la b&#250;squeda activa de <span class="elsevierStyleItalic">Leishmania</span> spp&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflictos de inter&#233;s</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflictos de inter&#233;s&#46;</p></span></span>"
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            1 => "Linfohistiocitosis hemofagoc&#237;tica"
            2 => "Infecci&#243;n"
            3 => "Citomegalovirus"
            4 => "<span class="elsevierStyleItalic">Leishmania</span>"
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            0 => "Haemophagocytic syndrome"
            1 => "Haemophagocytic lymphohistiocytosis"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome hemofagoc&#237;tico &#40;SHF&#41; es un trastorno inmunol&#243;gico grave caracterizado por una inflamaci&#243;n descontrolada con fracaso multiorg&#225;nico&#46; Puede estar desencadenado por infecciones v&#237;ricas&#44; bacterianas&#44; f&#250;ngicas o parasitarias&#46; Se describe nuestra experiencia de SHF asociado a infecciones y se estima su incidencia local&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo observacional de SHF asociado a infecciones en adultos atendidos en el Servicio de Patolog&#237;a Infecciosa de un hospital universitario durante 5<span class="elsevierStyleHsp" style=""></span>a&#241;os y revisi&#243;n de las series publicadas en Europa&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 2<span class="elsevierStyleHsp" style=""></span>mujeres con enfermedad de Crohn&#44; el SHF se asoci&#243; a infecci&#243;n por citomegalovirus y a leishmaniosis visceral &#40;mieloma m&#250;ltiple 1&#44; tumor s&#243;lido 2&#44; sin enfermedad evidente 1&#41; en 4<span class="elsevierStyleHsp" style=""></span>pacientes &#40;3 hombres&#41;&#46; Fallecieron 2<span class="elsevierStyleHsp" style=""></span>enfermos&#46; La incidencia estimada fue 0&#44;58&#47;100&#46;000&#47;a&#241;o&#46; Las series publicadas son heterog&#233;neas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El SHF asociado a infecciones debe de ser m&#225;s frecuente de lo descrito&#46; El entorno geogr&#225;fico puede influir en las infecciones desencadenantes &#40;en nuestro medio&#44; debe buscarse <span class="elsevierStyleItalic">Leishmania&#41;&#46;</span></p></span>"
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            "titulo" => "Material y m&#233;todo"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Haemophagocytic syndrome &#40;HPS&#41; is a severe immunological disorder characterised by uncontrolled inflammation and multiple organ failure&#46; HPS can be triggered by viral&#44; bacterial&#44; fungal and parasitical infections&#46; We report our experience with infection-related HPS and estimate its local incidence&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and method</span><p id="spar0030" 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&#44; as well as a review of the published series in Europe&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">HPS was associated with infection by cytomegalovirus in 2 women with Crohn&#39;s disease and was associated with visceral leishmaniosis in 4 patients &#40;3 men&#44; 1 woman&#59; 1 case of multiple myeloma&#59; 2 cases of solid tumours&#59; 1 case of no apparent disease&#41;&#46; Two patients died&#44; and the estimated incidence rate was 0&#46;58&#47;100&#44;000 inhabitants&#47;year&#46; The published series are mixed&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Infection-related HPS must be more common than reported&#46; The geographical environment can influence the triggering infections &#40;in our environment&#44; Leishmania should be considered&#41;&#46;</p></span>"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ABL&#58; anfotericina B liposomal&#59; CMV&#58; citomegalovirus&#59; Hb&#58; hemoglobina&#59; MO&#58; m&#233;dula &#243;sea&#59; PCR&#58; reacci&#243;n en cadena de la polimerasa&#46;</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">A&#241;o&#47;caso&nbsp;\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&#47;1&nbsp;\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&#47;2&nbsp;\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&#47;3&nbsp;\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&#47;4&nbsp;\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&#47;5&nbsp;\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&#47;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="\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">Edad&#47;sexo&nbsp;\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&#47;M&nbsp;\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&#47;M&nbsp;\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&#47;V&nbsp;\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&#47;M&nbsp;\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&#47;V&nbsp;\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&#47;V&nbsp;\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">Situaci&#243;n predisponente&nbsp;\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">Enfermedad de Crohn&nbsp;\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">Adenocarcinoma de endometrio&nbsp;\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">&#8211;&nbsp;\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">Enfermedad de Crohn&nbsp;\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">Mieloma m&#250;ltiple&nbsp;\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">Carcinoma urotelial&nbsp;\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">Tratamientos previos&nbsp;\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">Azatioprina&#44; prednisona&#44; infliximab&nbsp;\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">Quimioterapia&nbsp;\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">&#8211;&nbsp;\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">Azatioprina&nbsp;\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&#44; dexametasona&nbsp;\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">&#8211;&nbsp;\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">C&#237;nica&nbsp;\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">Fiebre&nbsp;\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">Fiebre y esplenomegalia&nbsp;\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">Fiebre y esplenomegalia&nbsp;\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">Fiebre&nbsp;\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">Fiebre y esplenomegalia&nbsp;\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">Fiebre y esplenomegalia&nbsp;\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">Hemograma&nbsp;\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&#44;1 g&#47;dl&#44;neutr&#243;filos 800&#47;mm<span class="elsevierStyleSup">3</span>&#44;plaquetas45&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\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&#44;1 g&#47;dl&#44;leucocitos 900&#47;mm<span class="elsevierStyleSup">3</span>&#44; plaquetas 18&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\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&#44;4 g&#47;dl&#44; leucocitos 1&#46;900&#47;mm<span class="elsevierStyleSup">3</span>&#44; plaquetas 63&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\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&#44;3 g&#47;dl&#44; leucocitos 1&#46;500&#47;mm<span class="elsevierStyleSup">3</span>&#44;plaquetas 11&#46;900&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\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&#44;5 g&#47;dl&#44;leucocitos 700&#47;mm<span class="elsevierStyleSup">3</span>&#44; plaquetas 33&#46;000&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\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&#44;3 g&#47;dl&#44;leucocitos 400&#47;mm<span class="elsevierStyleSup">3&#44;</span> plaquetas 36&#46;000&#47;mm<span class="elsevierStyleSup">3</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="\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">Fibrin&#243;geno&nbsp;\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 mg&#47;dl&nbsp;\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">&#60; 100 mg&#47;dl&nbsp;\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&nbsp;\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&nbsp;\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 mg&#47;dl&nbsp;\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 mg&#47;dl&nbsp;\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">Triglic&#233;ridos&nbsp;\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 mg&#47;dl&nbsp;\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 mg&#47;dl&nbsp;\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 mg&#47;dl&nbsp;\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 mg&#47;dl&nbsp;\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 mg&#47;dl&nbsp;\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&nbsp;\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">Ferritina&nbsp;\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&#46;020 ng&#47;ml&nbsp;\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">&#62; 7&#46;000 ng&#47;ml&nbsp;\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">9&#46;400 ng&#47;ml&nbsp;\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&#46;098 ng&#47;ml&nbsp;\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&#46;581 ng&#47;ml&nbsp;\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&#46;940 ng&#47;ml&nbsp;\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">Linfocitos CD4&#43;&nbsp;\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&#47;&#956;l&nbsp;\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&#47;&#956;l&nbsp;\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&#47;&#956;l&nbsp;\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&#47;&#956;l&nbsp;\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&#47;&#956;l&nbsp;\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">&#8211;&nbsp;\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">MO&nbsp;\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">Hemofagocitos&nbsp;\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">&#8211;&nbsp;\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">Hemofagocitos&nbsp;\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">Hemofagocitos&nbsp;\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">Hemofagocitos&nbsp;\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">Hemofagocitos&nbsp;\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">Infecci&#243;nDiagn&#243;stico&nbsp;\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">CMVPCR sangre&nbsp;\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">Leishmaniosis visceralSerolog&#237;a&nbsp;\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">Leishmaniosis visceralPCR en MO&nbsp;\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">CMVPCR sangre y MO&nbsp;\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">Leishmaniosis visceralPCR en MO&nbsp;\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">Leishmaniosis visceralPCR en MO&nbsp;\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">Tratamiento&nbsp;\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&#44;dexametasonaetop&#243;sido&#44;flebogamma&#44; fibrin&#243;geno&nbsp;\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">ABL&#44;dexametasona&nbsp;\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">ABL&#44;dexametasona&#44; ciclosporina&nbsp;\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&#44; dexametasona&nbsp;\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">ABL&#44;dexametasona&#44;etop&#243;sido&#44;ciclosporina&nbsp;\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">ABL&#44; dexametasonaetop&#243;sido&#44; cicloscopina&nbsp;\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">Evoluci&#243;n&nbsp;\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">Fallecimiento&nbsp;\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">Buena&nbsp;\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">Buena&nbsp;\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">Buena&nbsp;\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">Fallecimiento&nbsp;\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">Buena&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CMV&#58; citomegalovirus&#59; EBMT&#58; European Society of Blood and Bone Marrow Transplantation&#59; HHV-8&#58; virus herpes humano 8&#59; IDP&#58; inmunodeficiencias primarias&#59; Leish&#58; <span class="elsevierStyleItalic">Leishmania</span>&#59; MNT&#58; micobacterias no tuberculosas&#59; SHF&#58; s&#237;ndrome hemofagoc&#237;tico&#59; SLP&#58; s&#237;ndromes linfoproliferativos &#40;incluyen linfomas T&#44; B y NK&#44; leucemia linf&#225;tica cr&#243;nica&#44; linfoma cerebral primario y enfermedad de Castleman&#41;&#59; TBC&#58; tuberculosis&#59; TNF&#58; factor de necrosis tumoral&#59; VEB&#58; virus de Epstein-Barr&#59; VHS&#58; virus herpes simple&#59; VIH&#58; virus de la inmunodeficiencia humana&#46;</p>"
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                  <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">Primer autor y a&#241;o&nbsp;\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">Pa&#237;s&#44;centros&#44;a&#241;os&nbsp;\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">N&#250;mero de infecciones&#47;total SHF&nbsp;\t\t\t\t\t\t\n
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                  \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&nbsp;\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&nbsp;\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">VEB&nbsp;\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">Otras infecciones&nbsp;\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">Patolog&#237;a de base&nbsp;\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">FallecidosFactores&nbsp;\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&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a>&nbsp;\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">Europa &#40;EBMT&#41;SHF en IDP<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Multic&#233;ntrico y revisi&#243;n literatura anterior a 2014&nbsp;\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">6&#47;63&nbsp;\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">&#8211;&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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">IDP todos&nbsp;\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 &#40;33&#37;&#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="\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">Hern&#225;ndez-Jim&#233;nez et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a>&nbsp;\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">Espa&#241;a&#44; SHFUn centro2010-2015&nbsp;\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">6&#47;18&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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">&nbsp;\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">SLP 7Otra neoplasia 1Autoinmune 1&nbsp;\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 &#40;17&#37;&#41;Neoplasias 6&#47;8 67&#37;&nbsp;\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-Zer&#243;n et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a>&nbsp;\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">Revisi&#243;n literatura SHF&#44; en tratados con biol&#243;gicos1996-2013&nbsp;\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
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                  \t\t\t\t">20&#47;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">TBC 5Histoplasmosis 3<span class="elsevierStyleItalic">Escherichia coli</span> 2<span class="elsevierStyleItalic">Staphylococcus aureus</span> 1Brucelosis 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Autoinmune 24SLP 6Anti-TNF 19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;20&#37;&#41;TBC 60&#37;&#62; 65 a&#241;os 62&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Lerolle et al&#46;&#44; 2016<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Francia&#44; SHFTres centros2006-2011&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">TBC 10Pi&#243;genas 7Toxoplasmosis 4MNT 3Malaria 3HHV-8 2VHS 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;32&#37;&#41;Todos inmunodeprimidos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">HHV-8 6VIH 1&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Adult haemophagocytic syndrome"
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                          "autores" => array:5 [
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                      "doi" => "10.1016/S0140-6736(13)61048-X"
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                        "fecha" => "2014"
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                        "paginaFinal" => "1516"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24290661"
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemophagocytic syndromes &#40;HPSs&#41; including hemophagocytic lymphohistiocytosis &#40;HLH&#41; in adults&#58; A systematic scoping review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "S&#46; Park"
                            2 => "D&#46; Giustini"
                            3 => "A&#46;Y&#46; Lee"
                            4 => "L&#46;Y&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Blood Rev"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "411"
                        "paginaFinal" => "420"
                      ]
                    ]
                  ]
                ]
              ]
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              "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&#46; Zhang"
                            1 => "J&#46; Zhou"
                            2 => "L&#46; Sokol"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/107327481402100406"
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                        "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"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0115"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemophagocytic lymphohistiocytosis&#58; Review of etiologies and management"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;R&#46; George"
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                        "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"
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                    0 => array:2 [
                      "titulo" => "HLH-2004&#58; Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis"
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                          "etal" => true
                          "autores" => array:6 [
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                        "tituloSerie" => "Pediatr Blood Cancer"
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                        "volumen" => "48"
                        "paginaInicial" => "124"
                        "paginaFinal" => "131"
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                    0 => array:2 [
                      "titulo" => "Nationwide survey of hemophagocytic lymphohistiocytosis in Japan"
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                          "autores" => array:6 [
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                            2 => "S&#46; Imashuku"
                            3 => "M&#46; Yasukawa"
                            4 => "H&#46; Tsuda"
                            5 => "I&#46; Miura"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Hematol"
                        "fecha" => "2007"
                        "volumen" => "86"
                        "paginaInicial" => "58"
                        "paginaFinal" => "65"
                      ]
                    ]
                  ]
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                0 => array:2 [
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                      "titulo" => "Malignancy-associated hemophagocytic lymphohistiocytosis in adults&#58; A retrospective population-basedanalysis from a single center"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            2 => "M&#46; Klimkowska"
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                          ]
                        ]
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                    ]
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                    0 => array:2 [
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                        "fecha" => "2011"
                        "volumen" => "52"
                        "paginaInicial" => "613"
                        "paginaFinal" => "619"
                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Diversity and combinations of infectious agents in 38 adults with an infection-triggered reactive haemophagocytic syndrome&#58; A multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; Laanani"
                            2 => "S&#46; Rivi&#232;re"
                            3 => "L&#46; Galicier"
                            4 => "P&#46; Coppo"
                            5 => "J&#46;L&#46; Meynard"
                          ]
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                    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"
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                          ]
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              "etiqueta" => "9"
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                    0 => array:2 [
                      "titulo" => "Infection is the major trigger of hemophagocytic syndrome in adult patients treated with biological therapies"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "M&#46; P&#233;rez-de-Lis"
                            3 => "R&#46; P&#233;rez-&#193;lvarez"
                            4 => "G&#46; Fraile"
                            5 => "H&#46; Gheitasi"
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                      "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"
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                          ]
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                    ]
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                ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How I treat hemophagocytic lymphohistiocytosis in the adult patient"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;M&#46; Schram"
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                  "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"
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            10 => array:3 [
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              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemophagocytic lymphohistiocytosis&#58; Analysis of 18 cases"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Hern&#225;ndez-Jim&#233;nez"
                            1 => "C&#46; D&#237;az-Pedroche"
                            2 => "J&#46; Laureiro"
                            3 => "O&#46; Madrid"
                            4 => "E&#46; Mart&#237;n"
                            5 => "C&#46; Lumbreras"
                          ]
                        ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2016"
                        "volumen" => "147"
                        "paginaInicial" => "495"
                        "paginaFinal" => "498"
                      ]
                    ]
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              ]
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              "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&#58; Analysis of a single institution series of 35 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Cattaneo"
                            1 => "M&#46; Oberti"
                            2 => "C&#46; Skert"
                            3 => "A&#46; Passi"
                            4 => "M&#46; Farina"
                            5 => "A&#46; 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&#58; Implications for differential diagnosis and pathogenesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;F&#46; Bode"
                            1 => "S&#46; Ammann"
                            2 => "W&#46; Al-Herz"
                            3 => "M&#46; Bataneant"
                            4 => "C&#46;C&#46; Dvorak"
                            5 => "S&#46; 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&#58; An update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Faucher"
                            1 => "R&#46; 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&#44; laboratory&#44; and treatment outcome characteristics of visceral leishmaniasis&#58; Results from a seven-year retrospective study in Greece"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;P&#46; Georgiadou"
                            1 => "A&#46; Stefos"
                            2 => "G&#46; Spanakos"
                            3 => "S&#46; Skrimpas"
                            4 => "K&#46; Makaritsis"
                            5 => "N&#46;V&#46; Sipsas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Infect Dis"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "46"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Linfohistiocitosis hemofagoc&#237;tica asociada a infecciones virales&#58; reto diagn&#243;stico y dilema terap&#233;utico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; Mostaza-Fern&#225;ndez"
                            1 => "J&#46; Laso"
                            2 => "D&#46; Carriedo Ule"
                            3 => "J&#46;M&#46;G&#46; Ruiz de Morales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2014.03.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Cl&#237;n 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&#58; A case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;K&#46; Patel"
                            1 => "A&#46;K&#46; Patel"
                            2 => "P&#46; Sarda"
                            3 => "B&#46;A&#46; Shah"
                            4 => "R&#46; 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&#46; Casadevall"
                            1 => "L&#46;A&#46; 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&#46;G&#46; Lokesh Babu"
                            1 => "D&#46; Boctor"
                            2 => "A&#46; Davey"
                            3 => "M&#46;C&#46; Bond"
                            4 => "K&#46; 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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Vol. 220. Núm. 2.
Páginas 109-114 (marzo 2020)
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Vol. 220. Núm. 2.
Páginas 109-114 (marzo 2020)
ORIGINAL BREVE
Síndrome hemofagocítico asociado a infecciones: no tan infrecuente
Haemophagocytic syndrome associated with infections: Not so uncommon
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217
F.F. Rodríguez Vidigal, A. Calvo Cano, M. Sánchez Sánchez, N. Nogales Muñoz, A. Vera Tomé, A. Muñoz Sanz
Autor para correspondencia
oyacoi@unex.es

Autor para correspondencia.
Servicio de Patología Infecciosa, Hospital Universitario de Badajoz. Universidad de Extremadura, Badajoz, España
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Tablas (2)
Tabla 1. SHF asociado a infecciones
Tabla 2. Series europeas de SHF asociado a infección en adultos
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Resumen
Introducción

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.

Material y método

Estudio retrospectivo observacional de SHF asociado a infecciones en adultos atendidos en el Servicio de Patología Infecciosa de un hospital universitario durante 5años y revisión de las series publicadas en Europa.

Resultados

En 2mujeres 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 4pacientes (3 hombres). Fallecieron 2enfermos. La incidencia estimada fue 0,58/100.000/año. Las series publicadas son heterogéneas.

Conclusiones

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 Leishmania).

Palabras clave:
Síndrome hemofagocítico
Linfohistiocitosis hemofagocítica
Infección
Citomegalovirus
Leishmania
Desencadenante
Abstract
Background

Haemophagocytic syndrome (HPS) is a severe immunological disorder characterised 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.

Material and method

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.

Results

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 tumours; 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.

Conclusions

Infection-related HPS must be more common than reported. The geographical environment can influence the triggering infections (in our environment, Leishmania should be considered).

Keywords:
Haemophagocytic syndrome
Haemophagocytic lymphohistiocytosis
Infection
Cytomegalovirus
Leishmania
Trigger

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