What is your diagnosis?
Case for diagnosis. Erythematous and infiltrated plaques in the infrahyoid region
Natália Tenório Cavalcante Bezerra
, Antonio Pedro Mendes Schettini, André Luiz Leturiondo, Liana Hortencia Miranda Tubilla Mathias
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Fundação Alfredo da Matta, Manaus, AM, Brazil
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Placas eritematosas e infiltradas na região infra‐hioidea" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "99" ] ] "contieneResumen" => array:1 [ "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 102010 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presença de vários bacilos álcool‐ácido resistentes na derme (Wade,100×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Natália Tenório Cavalcante Bezerra, Antonio Pedro Mendes Schettini, André Luiz Leturiondo, Liana Hortencia Miranda Tubilla Mathias" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Natália Tenório Cavalcante" "apellidos" => "Bezerra" ] 1 => array:2 [ "nombre" => "Antonio Pedro Mendes" "apellidos" => "Schettini" ] 2 => array:2 [ "nombre" => "André Luiz" "apellidos" => "Leturiondo" ] 3 => array:2 [ "nombre" => "Liana Hortencia Miranda Tubilla" "apellidos" => "Mathias" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S036505962030310X" "doi" => "10.1016/j.abd.2020.03.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962030310X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220303623?idApp=UINPBA00008Z" "url" => "/26662752/0000009600000001/v2_202102130748/S2666275220303623/v2_202102130748/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059620302993" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.06.004" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "285" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">What is your diagnosis?</span>" "titulo" => "Case for diagnosis. A pruritic eruption of keratotic papules over the face and neck" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "100" "paginaFinal" => "102" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 1750 "Tamanyo" => 223547 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple skin-colored to erythematous to brownish, 1 − 2 mm papules, with a slightly keratotic center, sometimes coalescing into verrucous plaques; koebnerization is also present.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria Relvas, Joana Calvão, Inês Coutinho, José Carlos Cardoso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maria" "apellidos" => "Relvas" ] 1 => array:2 [ "nombre" => "Joana" "apellidos" => "Calvão" ] 2 => array:2 [ "nombre" => "Inês" "apellidos" => "Coutinho" ] 3 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Cardoso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220303507" "doi" => "10.1016/j.abdp.2020.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220303507?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620302993?idApp=UINPBA00008Z" "url" => "/03650596/0000009600000001/v3_202102051036/S0365059620302993/v3_202102051036/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059620303007" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.07.003" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "286" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Topical corticosteroid induced ulcerated striae" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "94" "paginaFinal" => "96" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 703 "Ancho" => 1305 "Tamanyo" => 171623 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A), Two superficial oval ulcers over striae in the inguinal region. 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Erythematous and infiltrated plaques in the infrahyoid region" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "99" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Natália Tenório Cavalcante Bezerra, Antonio Pedro Mendes Schettini, André Luiz Leturiondo, Liana Hortencia Miranda Tubilla Mathias" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Natália Tenório Cavalcante" "apellidos" => "Bezerra" "email" => array:1 [ 0 => "ntltenorio@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Antonio Pedro Mendes" "apellidos" => "Schettini" ] 2 => array:2 [ "nombre" => "André Luiz" "apellidos" => "Leturiondo" ] 3 => array:2 [ "nombre" => "Liana Hortencia Miranda Tubilla" "apellidos" => "Mathias" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Fundação Alfredo da Matta, Manaus, AM, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 676 "Ancho" => 900 "Tamanyo" => 130520 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presence of several acid-fast bacilli in the dermis (Wade, ×100).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 46-year-old male presented two erythematous infiltrated plaques for 30 days, with changes in thermal, tactile and painful sensitivity on the infrahyoid region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He also reported diarrhea and the loss of 8 kg in four months. The bacilloscopy was negative. Histopathology showed a diffuse inflammatory dermal infiltrate made up of epithelioid histiocytes and focal foam cells, lymphocytes, and giant Langhans cells, distributed around vessels, adnexa, and nerves (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Several isolated and fragmented bacilli were demonstrated in the papillary dermis using the Wade-Fite method (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The polymerase chain reaction (PCR) was positive for Mycobacterium leprae, and culture for other mycobacteria was negative. Serology for syphilis and HIV was positive, with a CD4 of 223 and a viral load of 221,601 copies. With the diagnosis of borderline-virchowian leprosy, he started treatment with multibacillary multidrug therapy, benzathine penicillin, and antiretroviral therapy, with partial regression of the lesions after two months (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What is your diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0015" class="elsevierStylePara elsevierViewall">Atypical mycobacteriosis</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Sarcoidosis</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Leprosy</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Cutaneous tuberculosis</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the interactions between Mycobacterium leprae (<span class="elsevierStyleItalic">M. leprae</span>) and the host's immune response, leprosy presents great clinical polymorphism, justifying the several classifications of the disease proposed throughout history.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There was an assumption that, in patients co-infected with leprosy and HIV, the compromised immune system could interfere in several clinical-pathological aspects of leprosy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, studies have shown that there is no direct impact on the rate of detection of the disease in HIV-positive patients, and that the classic clinical forms prevail. Leprosy reactions also do not appear to be more frequent, and the treatment is effective at the usual doses and duration.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In the reported case, the patient had an unusual clinical picture, mimicking various diseases, making it difficult to diagnose and prescribe the appropriate therapeutic regimen. The conclusion was established by tests not available in primary healthcare units. Bacilloscopy, performed by intradermal scraping of four sites, one of them being the infrahyoid lesion, was negative even after being repeated. In an unusual way, the histopathological examination showed that the bacilli were located at the limit between the papillary and reticular dermis and were restricted to a certain field, rather than distributed diffusely. The clinical-pathological categorization of the patient then became a challenge.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors chose to classify it as borderline-virchowian (Ridley and Jopling classification) based on the histopathological findings that showed characteristics of the tuberculoid pole (epithelial granulomas) and the virchowian pole (vacuolated histiocytes) in the same biopsy, possibly registering a transition from the borderline-borderline form to borderline-virchowian.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Routine examinations at the reference service enabled the diagnosis of comorbidities (AIDS and syphilis) in this patient. It was also possible to perform tests such as histopathology and PCR, which allowed the diagnostic conclusion of leprosy in an atypical clinical lesion.</p><p id="par0060" class="elsevierStylePara elsevierViewall">It is important to emphasize that the basic health care network must have reference services which provide technical capabilities to confirm or rule out the diagnosis of leprosy in patients whose clinical presentation differs from the usual.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Natália Tenório Cavalcante Bezerra: Drafting and editing of the manuscript; critical review of the literature.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Antonio Pedro Mendes Schettini: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">André Luiz Leturiondo: Intellectual participation in propaedeutic and/or therapeutic conduct of studied cases.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Liana Hortência Miranda Tubilla Mathias: Intellectual participation in propaedeutic and/or therapeutic conduct of studied cases.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1461422" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1331606" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "What is your diagnosis?" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-13" "fechaAceptado" => "2020-03-05" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1331606" "palabras" => array:3 [ 0 => "Diagnosis, differential" 1 => "HIV infections" 2 => "Leprosy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Leprosy is a chronic infectious disease caused by <span class="elsevierStyleItalic">Mycobacterium leprae</span> and, depending on the host immune status, presents different clinical forms. This report describes the case of a 46-year-old man who had hypoesthetic lesions in the infrahyoid region for 30 days. The bacilloscopy was negative. The anatomopathological examination showed alterations corresponding to the tuberculoid pole (epithelioid histiocytes) and virchowian pole (foamy histiocytes), compatible with borderline-virchowian leprosy (Ridley and Jopling classification). Rapid tests for HIV I, II, and syphilis were positive, with a CD4 count of 223. The patient started treatment with multibacillary multidrug therapy, antiretroviral therapy, and benzathine penicillin, with marked clinical improvement in two months.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Bezerra NTC, Schettini APM, Leturiondo AL, Mathias LHMT. Case for diagnosis. Erythematous and infiltrated plaques in the infrahyoid region. An Bras Dermatol. 2021;96:97–9.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Fundação Alfredo da Matta, Manaus, AM, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1104 "Ancho" => 750 "Tamanyo" => 139995 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous and infiltrated plaques, confluent in the infrahyoid region, with well-defined edges.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 601 "Ancho" => 1250 "Tamanyo" => 288507 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A), Dermal granulomatous inflammatory process with epithelioid cells, giant cells and lymphocytes (Hematoxylin & eosin, ×100). (B), Dermal inflammatory process with foamy histiocytes (Hematoxylin & eosin, ×400).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 676 "Ancho" => 900 "Tamanyo" => 130520 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presence of several acid-fast bacilli in the dermis (Wade, ×100).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 599 "Ancho" => 900 "Tamanyo" => 71258 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Aspect of the lesions after two months of multidrug treatment for multibacillary leprosy. The lesions are impregnated with clofazimine.</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" => "WHO Expert Committee on Leprosy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "World Health Organ Tech Rep Ser." 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 23 | 8 | 31 |
| 2024 Outubro | 108 | 74 | 182 |
| 2024 Setembro | 136 | 88 | 224 |
| 2024 Agosto | 164 | 124 | 288 |
| 2024 Julho | 138 | 109 | 247 |
| 2024 Junho | 126 | 86 | 212 |
| 2024 Maio | 97 | 67 | 164 |
| 2024 Abril | 104 | 89 | 193 |
| 2024 Março | 92 | 66 | 158 |
| 2024 Fevereiro | 117 | 88 | 205 |
| 2024 Janeiro | 102 | 48 | 150 |
| 2023 Dezembro | 56 | 60 | 116 |
| 2023 Novembro | 76 | 69 | 145 |
| 2023 Outubro | 68 | 75 | 143 |
| 2023 Setembro | 67 | 75 | 142 |
| 2023 Agosto | 57 | 33 | 90 |
| 2023 Julho | 70 | 56 | 126 |
| 2023 Junho | 58 | 47 | 105 |
| 2023 Maio | 61 | 20 | 81 |
| 2023 Abril | 38 | 22 | 60 |
| 2023 Março | 52 | 35 | 87 |
| 2023 Fevereiro | 48 | 38 | 86 |
| 2023 Janeiro | 32 | 22 | 54 |
| 2022 Dezembro | 45 | 27 | 72 |
| 2022 Novembro | 66 | 58 | 124 |
| 2022 Outubro | 78 | 53 | 131 |
| 2022 Setembro | 49 | 69 | 118 |
| 2022 Agosto | 38 | 42 | 80 |
| 2022 Julho | 36 | 60 | 96 |
| 2022 Junho | 43 | 57 | 100 |
| 2022 Maio | 26 | 48 | 74 |
| 2022 Abril | 40 | 49 | 89 |
| 2022 Março | 45 | 82 | 127 |
| 2022 Fevereiro | 30 | 35 | 65 |
| 2022 Janeiro | 63 | 94 | 157 |
| 2021 Dezembro | 40 | 61 | 101 |
| 2021 Novembro | 50 | 69 | 119 |
| 2021 Outubro | 59 | 83 | 142 |
| 2021 Setembro | 45 | 61 | 106 |
| 2021 Agosto | 50 | 56 | 106 |
| 2021 Julho | 50 | 48 | 98 |
| 2021 Junho | 52 | 53 | 105 |
| 2021 Maio | 90 | 97 | 187 |
| 2021 Abril | 219 | 366 | 585 |
| 2021 Março | 165 | 107 | 272 |
| 2021 Fevereiro | 67 | 17 | 84 |
| 2021 Janeiro | 43 | 20 | 63 |
| 2020 Dezembro | 10 | 11 | 21 |
| 2020 Novembro | 1 | 2 | 3 |
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