Case Report
Rothia mucilaginosa Pneumonia in an Immunocompetent Patient
Neumonía por Rothia mucilaginosa en paciente inmunocompetente
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(B) Chest computed tomography showing parenchymal consolidation and ground-glass opacities in right segment 3 and part of apical and anterior segments with air bronchogram and a fully patent bronchus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Rothia mucilaginosa</span> is a Gram-positive coagulase-negative coccus, known until 2000 as <span class="elsevierStyleItalic">Stomatococcus mucilaginosus</span>. It can be difficult to identify, and confusion with <span class="elsevierStyleItalic">Micrococcus</span>, <span class="elsevierStyleItalic">Streptococcus</span> or <span class="elsevierStyleItalic">Staphylococcus</span> may lead to underdiagnosis. The genus <span class="elsevierStyleItalic">Rothia</span> belongs to the <span class="elsevierStyleItalic">Micrococcaceae</span> family and at least four species have been recognized: <span class="elsevierStyleItalic">Rothia dentocariosa</span>, <span class="elsevierStyleItalic">mucilaginosa</span>, <span class="elsevierStyleItalic">nasimurium</span> and <span class="elsevierStyleItalic">amarae</span>. The first two species form part of the oropharyngeal microflora, and have been described as the causative agents of several diseases in humans. It was first described as a source of infection in humans in a case of endocarditis published in 1978.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In recent years it has been isolated primarily in immunocompromised patients and more rarely in immunocompetent subjects. Cases of bacteremia, endocarditis, central nervous system infections, urinary infections, osteomyelitis, peritonitis, and, very occasionally, lower respiratory tract infections have been reported.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We describe here a case of pneumonia due to <span class="elsevierStyleItalic">R. mucilaginosa</span>, initially presenting as hemoptysis, in an immunocompetent patient, and we review the experience in our hospital over the last four years.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 47-year-old woman, non-smoker, was admitted to our hospital with a 15-day history of right pleuritic chest pain and scant hemoptysis. She had previously received treatment with levofloxacin without improvement.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient did not report any significant disease history, except for mild intermittent asthma not requiring inhaled corticosteroids.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Chest X-ray (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) revealed alveolar infiltrate in the right upper lobe (RUL) with loss of volume. Chest CT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) showed parenchymal consolidation with ground-glass opacities. <span class="elsevierStyleItalic">R. mucilaginosa</span> was isolated on two occasions from sputum cultures (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Fiberoptic bronchoscopy was performed, revealing transparent secretions with bloody traces originating in the RUL. <span class="elsevierStyleItalic">R. mucilaginosa</span> was also isolated from the bronchial aspirate (>10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>CFU/ml). Results from blood culture, <span class="elsevierStyleItalic">Legionella/Pneumococcus</span> antigens in urine, Mantoux, HIV serology, immunoglobulins, and sweat test were all normal. She was treated with amoxicillin-clavulanate for 14 days with full radiological resolution. The patient also underwent spirometric testing which was normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">R. mucilaginosa</span> isolates identified with mass spectrometry (MALDI-TOF) in the microbiology laboratory of our hospital between March 2009 and March 2013 were reviewed. During this period, the coccus was isolated in 22 patients from sputum (13), blood (4), pleural fluid (2), peritoneal cavity fluid (1), urine (1) and bronchial aspirate (1) samples. Sputum samples were good quality (sputum>25 polymorphonuclear leukocytes and <10 epithelial cells). None of the isolates were resistant to third-generation cephalosporins. Penicillin resistance was determined in 17% of the cases and quinolone resistance in 50%. A total of 42% of the subjects had received empirical treatment with levofloxacin, 37% with third-generation cephalosporins, and 21% with other antibiotics.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The most prevalent infections were bronchitis/exacerbations of bronchiectasis (50%), bacteremia (14%), pleural empyema (9%), pneumonia (9%), ascites (9%) and urinary infection (9%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Two of our patients were completely healthy. Six were immunocompromised (five had active oncohematological disease and another was receiving cyclophosphamide for pulmonary fibrosis associated with rheumatoid arthritis). Finally, there were 14 non-immunocompromised patients who presented comorbidities. Of these, eight (57%) had COPD with bronchiectasis but had not received systemic steroids in the previous three months.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">We report a case of pneumonia in which <span class="elsevierStyleItalic">R. mucilaginosa</span> was the single agent isolated from two good quality sputum samples and bronchial aspirate in an apparently immunocompetent patient. This microbe is rarely identified as a causative agent in lower respiratory tract infection.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Clinical manifestations range from mild bronchitis to recurrent pneumonia and pulmonary abscess,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and most patients have some form of immunodeficiency. The clinical significance of <span class="elsevierStyleItalic">R. mucilaginosa</span> in respiratory samples is difficult to determine; in the diagnosis of <span class="elsevierStyleItalic">R. mucilaginosa</span> pneumonia, therefore, it is advisable to obtain a culture from a bronchoscopy specimen.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Vancomycin, third-generation cephalosporins and rifampicin are the treatments of choice for this disease. Sensitivity to penicillin, clindamycin and macrolides can be variable, while resistance rates to quinolones and aminoglycosides are higher.</p><p id="par0050" class="elsevierStylePara elsevierViewall">According to the review performed in our hospital, 22 cases of infection due to this microbe were diagnosed in a 4-year period, two of which were pneumonia (the case described here and another patient with lung cancer). It is worth mentioning that a predisposing factor in 8 of our patients with <span class="elsevierStyleItalic">R. mucilaginosa</span> isolated in sputum was COPD with bronchiectasis. Accordingly, this coccus should be considered in patients of this type, even if there is no evidence of immunodeficiency, given the possibility of resistance to empirical antibiotics habitually used in this situation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of Interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests directly or indirectly associated with the content of this manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres379780" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec358592" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres379779" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec358591" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of Interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-14" "fechaAceptado" => "2013-12-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec358592" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Rothia mucilaginosa</span>" 1 => "Pneumonia" 2 => "Low respiratory tract infections" 3 => "Immunocompetent" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec358591" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Rothia mucilaginosa</span>" 1 => "Neumonía" 2 => "Infecciones del tracto respiratorio inferior" 3 => "Inmunocompetente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Rothia mucilaginosa</span> is a gram-positive coccus that occurs as part of the normal flora of the oropharynx and upper respiratory tract. Lower respiratory tract infections caused by this organism are rare and usually occur in immunocompromised patients. This is the case of an immunocompetent 47-year-old woman with right upper lobe pneumonia in which <span class="elsevierStyleItalic">R. mucilaginosa</span> was isolated in sputum and bronchial aspirate. Infections caused by this agent in the last four years in our hospital were reviewed. The most common predisposing factor was COPD with bronchiectasis. <span class="elsevierStyleItalic">R. mucilaginosa</span> was identified as the causative agent for pneumonia in only two cases, of which one was our case and the other was a patient with lung cancer.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Rothia mucilaginosa</span> es un coco grampositivo que forma parte de la flora normal de la orofaringe y del tracto respiratorio superior. Las infecciones del tracto respiratorio inferior por este germen son infrecuentes y se presentan habitualmente en pacientes inmunocomprometidos. Presentamos una mujer de 47<span class="elsevierStyleHsp" style=""></span>años inmunocompetente con neumonía en lóbulo superior derecho en la que se aísla <span class="elsevierStyleItalic">R. mucilaginosa</span> en esputo y en broncoaspirado. Además se revisan las infecciones por este germen en los últimos cuatro<span class="elsevierStyleHsp" style=""></span>años en nuestro hospital. En dicha revisión el factor predisponente más frecuente ha sido la EPOC con bronquiectasias, y en solo dos casos se ha identificado el germen como agente causante de neumonía, entre los que se encuentra nuestro caso y el de un paciente con una neoplasia pulmonar.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Baeza Martínez C, Zamora Molina L, García Sevila R, Gil Carbonell J, Ramos Rincon JM, Martín Serrano C. Neumonía por <span class="elsevierStyleItalic">Rothia mucilaginosa</span> en paciente inmunocompetente. Arch Bronconeumol. 2014;50:493–495.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 532 "Ancho" => 1301 "Tamanyo" => 100414 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Posteroanterior chest X-ray showing alveolar condensation and loss of volume in right upper lobe. (B) Chest computed tomography showing parenchymal consolidation and ground-glass opacities in right segment 3 and part of apical and anterior segments with air bronchogram and a fully patent bronchus.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">MIC: minimum inhibitory concentration (μg/ml); R: resistant; S: sensitive; TMP/SMX: trimethoprim-sulfamethoxazole.</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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">MIC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">MIC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">MIC \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Amoxicillin/clavulanate \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">S \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">0.06 \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">Ampicillin \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">S \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">≤0.03 \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">Aztreonam \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">R \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">256 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Cefotaxime \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">S \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">≤0.016 \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">Cefuroxime \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">S \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">0.75 \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">Cloramphenicol \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">S \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">0.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Ciprofloxacin \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">R \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">32 \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">Clarithromycin \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">S \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">≤0.016 \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">Imipenem \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">S \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">≤0.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">TMP/SMX \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">S \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">≤0.2 \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="" 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="" 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="" 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="" 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="" 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="" 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></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab578290.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Antibiogram of the <span class="elsevierStyleItalic">Rothia mucilaginosa</span> Isolated in Sputum and Bronchial Aspirate.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endocarditis associated with cardiac catheterization due to a Gram positive coccus designated <span class="elsevierStyleItalic">Micrococcus mucilaginosus</span> incertae sedis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.J. Rubin" 1 => "R.W. Lyons" 2 => "A.J. Murcia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1978" "volumen" => "7" "paginaInicial" => "546" "paginaFinal" => "549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/670378" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polmonite paucisintomatica da <span class="elsevierStyleItalic">Rothia mucilaginosa</span>: caso clinica e rassegna della letteratura" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Fusconi" 1 => "C. Conti" 2 => "A. de Virgilio" 3 => "M. Vincentiis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Infez Med" "fecha" => "2009" "volumen" => "2" "paginaInicial" => "100" "paginaFinal" => "104" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Stomatococcus mucilaginosus</span> lower respiratory tract infection in a patient with AIDS" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.G. Cunniffe" 1 => "C. Mallia" 2 => "P.A. Alcock" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Infect" "fecha" => "1994" "volumen" => "29" "paginaInicial" => "327" "paginaFinal" => "330" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7884227" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eight cases of lower respiratory tract infection caused by <span class="elsevierStyleItalic">Stomatococcus mucilaginosus</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.L. Korsholm" 1 => "V. Haahr" 2 => "J. Prag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365540701387064" "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "2007" "volumen" => "39" "paginaInicial" => "913" "paginaFinal" => "917" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17886126" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Rothia mucilaginosa</span> pneumonia diagnosed by quantitative cultures and intracellular organism of bronchoalveolar lavage in a lymphoma patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Cho" 1 => "H. Sung" 2 => "S. Park" 3 => "M. Kim" 4 => "S. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3343/alm.2013.33.2.145" "Revista" => array:6 [ "tituloSerie" => "Ann Lab Med" "fecha" => "2013" "volumen" => "33" "paginaInicial" => "145" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23483615" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000011/v1_201410310135/S1579212914002584/v1_201410310135/en/main.assets" "Apartado" => array:4 [ "identificador" => "9347" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000011/v1_201410310135/S1579212914002584/v1_201410310135/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914002584?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 2 | 22 |
| 2024 October | 200 | 32 | 232 |
| 2024 September | 217 | 37 | 254 |
| 2024 August | 223 | 37 | 260 |
| 2024 July | 235 | 40 | 275 |
| 2024 June | 219 | 34 | 253 |
| 2024 May | 203 | 47 | 250 |
| 2024 April | 158 | 33 | 191 |
| 2024 March | 154 | 29 | 183 |
| 2024 February | 89 | 18 | 107 |
| 2023 March | 36 | 5 | 41 |
| 2023 February | 177 | 28 | 205 |
| 2023 January | 235 | 47 | 282 |
| 2022 December | 144 | 55 | 199 |
| 2022 November | 156 | 35 | 191 |
| 2022 October | 169 | 48 | 217 |
| 2022 September | 132 | 42 | 174 |
| 2022 August | 184 | 48 | 232 |
| 2022 July | 189 | 50 | 239 |
| 2022 June | 172 | 62 | 234 |
| 2022 May | 196 | 52 | 248 |
| 2022 April | 197 | 36 | 233 |
| 2022 March | 186 | 69 | 255 |
| 2022 February | 161 | 41 | 202 |
| 2022 January | 305 | 59 | 364 |
| 2021 December | 262 | 66 | 328 |
| 2021 November | 256 | 53 | 309 |
| 2021 October | 282 | 68 | 350 |
| 2021 September | 337 | 64 | 401 |
| 2021 August | 366 | 44 | 410 |
| 2021 July | 390 | 47 | 437 |
| 2021 June | 375 | 57 | 432 |
| 2021 May | 392 | 74 | 466 |
| 2021 April | 663 | 143 | 806 |
| 2021 March | 503 | 51 | 554 |
| 2021 February | 361 | 41 | 402 |
| 2021 January | 348 | 62 | 410 |
| 2020 December | 285 | 22 | 307 |
| 2020 November | 361 | 34 | 395 |
| 2020 October | 336 | 24 | 360 |
| 2020 September | 380 | 17 | 397 |
| 2020 August | 436 | 37 | 473 |
| 2020 July | 421 | 45 | 466 |
| 2020 June | 312 | 15 | 327 |
| 2020 May | 302 | 24 | 326 |
| 2020 April | 274 | 46 | 320 |
| 2020 March | 335 | 22 | 357 |
| 2020 February | 317 | 33 | 350 |
| 2020 January | 310 | 31 | 341 |
| 2019 December | 336 | 32 | 368 |
| 2019 November | 342 | 44 | 386 |
| 2019 October | 300 | 35 | 335 |
| 2019 September | 387 | 26 | 413 |
| 2019 August | 220 | 25 | 245 |
| 2019 July | 274 | 30 | 304 |
| 2019 June | 252 | 31 | 283 |
| 2019 May | 318 | 38 | 356 |
| 2019 April | 298 | 45 | 343 |
| 2019 March | 286 | 39 | 325 |
| 2019 February | 259 | 33 | 292 |
| 2019 January | 233 | 33 | 266 |
| 2018 December | 248 | 28 | 276 |
| 2018 November | 225 | 40 | 265 |
| 2018 October | 276 | 37 | 313 |
| 2018 September | 225 | 13 | 238 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 139 | 0 | 139 |
| 2018 April | 227 | 8 | 235 |
| 2018 March | 249 | 6 | 255 |
| 2018 February | 149 | 14 | 163 |
| 2018 January | 166 | 8 | 174 |
| 2017 December | 197 | 9 | 206 |
| 2017 November | 260 | 7 | 267 |
| 2017 October | 230 | 12 | 242 |
| 2017 September | 187 | 10 | 197 |
| 2017 August | 214 | 9 | 223 |
| 2017 July | 190 | 10 | 200 |
| 2017 June | 223 | 27 | 250 |
| 2017 May | 227 | 16 | 243 |
| 2017 April | 233 | 16 | 249 |
| 2017 March | 188 | 37 | 225 |
| 2017 February | 177 | 10 | 187 |
| 2017 January | 187 | 6 | 193 |
| 2016 December | 213 | 12 | 225 |
| 2016 November | 286 | 19 | 305 |
| 2016 October | 292 | 26 | 318 |
| 2016 September | 369 | 28 | 397 |
| 2016 August | 374 | 21 | 395 |
| 2016 July | 181 | 10 | 191 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 282 | 15 | 297 |
| 2015 September | 311 | 20 | 331 |
| 2015 August | 296 | 37 | 333 |
| 2015 July | 374 | 20 | 394 |
| 2015 June | 266 | 21 | 287 |
| 2015 May | 277 | 28 | 305 |
| 2015 April | 157 | 25 | 182 |
| 2015 March | 108 | 39 | 147 |
| 2015 February | 66 | 38 | 104 |
| 2015 January | 0 | 3 | 3 |
| 2014 November | 0 | 3 | 3 |
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