Case report
An infant with a mild SARS-CoV-2 infection detected only by anal swabs: a case report
a Pidu District People's Hospital, Department of Infectious Diseases, Chengdu, Sichuan Province, China
b Pidu District People's Hospital, Department of Cardiology, Chengdu, Deyuan Chengdu, Sichuan Province, China
c Changxing County Hospital, of Traditional Chinese Medicine, Department of Respiratory Medicine, Huzhou, Zhejiang Province, China
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Only complete genomes were used for tracing the phylogenetic history of B19V. The nucleotide substitution model used was TN<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>F<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>R2 for tree reconstruction, which was chosen by BIC (Bayesian Information Criterion) statistic model, utilizing 10,000 ultrafast bootstrap replicates for statistical significance. Only values of above 75% were demonstrated on important tree branches. The phylogenetic tree was constructed using the IQtree software v.16.12, applying the maximum likelihood approach.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael dos Santos Bezerra, Cristiane Fração Diefenbach, Dalnei Veiga Pereira, Simone Kashima, Svetoslav Nanev Slavov" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Rafael dos Santos" "apellidos" => "Bezerra" ] 1 => array:2 [ "nombre" => "Cristiane Fração" "apellidos" => "Diefenbach" ] 2 => array:2 [ "nombre" => "Dalnei Veiga" "apellidos" => "Pereira" ] 3 => array:2 [ "nombre" => "Simone" "apellidos" => "Kashima" ] 4 => array:2 [ "nombre" => "Svetoslav Nanev" "apellidos" => "Slavov" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1413867020300453?idApp=UINPBA00003Y" "url" => "/14138670/0000002400000003/v2_202008150754/S1413867020300453/v2_202008150754/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1413867020300441" "issn" => "14138670" "doi" => "10.1016/j.bjid.2020.04.010" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "976" "copyright" => "Sociedade Brasileira de Infectologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Braz J Infect Dis. 2020;24:239-46" "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">Review article</span>" "titulo" => "Clinical utilization of bacteriophages: a new perspective to combat the antimicrobial resistance in Brazil" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "239" "paginaFinal" => "246" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1576 "Ancho" => 3167 "Tamanyo" => 548466 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Timeline of the main events related to phage's research during the last decades. At the top of the figure, world events related to phage research, while in the bottom, the main researches that were conducted in Brazil. The investigations involving phages in Brazil were obtained through research in the PubMed, using the indicators “Bacteriophages AND Brazil” or “Phages AND Brazil”. For a better understanding or to request more information about events shown on the top of the figure, we suggest reading Salmond and Fineran.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">14</span></a> Additionally, for more information about the early studies carried out in Brazil, we suggest reading Almeida and Sundberg.<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Willames M.B.S. Martins, Mark A. Toleman, Ana C. Gales" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Willames M.B.S." "apellidos" => "Martins" ] 1 => array:2 [ "nombre" => "Mark A." "apellidos" => "Toleman" ] 2 => array:2 [ "nombre" => "Ana C." "apellidos" => "Gales" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1413867020300441?idApp=UINPBA00003Y" "url" => "/14138670/0000002400000003/v2_202008150754/S1413867020300441/v2_202008150754/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "An infant with a mild SARS-CoV-2 infection detected only by anal swabs: a case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "249" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Li, Jing Feng, Tian-hu Liu, Feng-cheng Xu, Guo-qiang Song" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Juan" "apellidos" => "Li" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Jing" "apellidos" => "Feng" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Tian-hu" "apellidos" => "Liu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Feng-cheng" "apellidos" => "Xu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:4 [ "nombre" => "Guo-qiang" "apellidos" => "Song" "email" => array:1 [ 0 => "wzyxysgq@126.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pidu District People's Hospital, Department of Infectious Diseases, Chengdu, Sichuan Province, China" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pidu District People's Hospital, Department of Cardiology, Chengdu, Deyuan Chengdu, Sichuan Province, China" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Changxing County Hospital, of Traditional Chinese Medicine, Department of Respiratory Medicine, Huzhou, Zhejiang Province, China" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "?" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 774 "Ancho" => 1500 "Tamanyo" => 198362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Normal chest CT findings at different sections: A and D, B and E, and C and F represent the same levels.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan and has spread rapidly in China, South Korea, and worldwide. Since December 2019, more than 120,000 people have been infected.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1–3</span></a> The SARS-CoV-2 genome has a nucleotide identity of 89% with bat SARS-like-CoVZXC21 and 82% with human SARS-CoV.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most common symptoms of infection are fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea is uncommon (3.8%). The median incubation period is four days (interquartile range 2–7). On admission, ground-glass opacities are the most common radiological finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with non-severe disease or in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> The diagnosis is confirmed by testing pharyngeal or nasal swabs for viral nucleic acids.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a Chinese Center for Disease Control and Prevention (CDC) report, the overall case-fatality rate was 2.3%, with 1023 deaths among 44,672 confirmed cases.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The pandemic has caused many social public health problems, leading to economic recession and panic.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> This is a global health problem and not just a problem in China.</p><p id="par0020" class="elsevierStylePara elsevierViewall">While patients with positive pharyngeal or nasal swabs have received much attention, asymptomatic or mildly ill patients with positive anal swabs have not. We know little about these patients, who may be shadows in the sun. However, they are potential sources of infection via fecal–oral transmission. Here, we present an asymptomatic baby in whom anal swabs were positive while pharyngeal swabs were persistently negative by real-time PCR testing.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">An 8-month-8-day-old girl was hospitalized with one day history of cough and runny nose on Feb 25, 2020. The patient was afebrile with no shortness of breath, clubbing, cyanosis, or abdominal distension. The patient was given oral ambroxol hydrochloride solution 15<span class="elsevierStyleHsp" style=""></span>mg, three times per day, with no improvement. The patient's mother, diagnosed with SARS-CoV-2 2 days earlier, had positive pharyngeal swab by real-time PCR testing and chest CT showing ground-glass opacities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">On physical examination, the patient had a body temperature of 38<span class="elsevierStyleHsp" style=""></span>°C, pulse of 116<span class="elsevierStyleHsp" style=""></span>beats/min, respiratory rate of 30<span class="elsevierStyleHsp" style=""></span>breaths/min, and oxygen saturation in room air of 99%. She was conscious and appeared acutely ill. There were no fluctuations in the nasal wings but some secretion in the nasal cavity, with redness, congestion, and a normal voice was observed. The breath sounds were normal in both lungs, with no dry or wet rales. Heart auscultation was normal. The abdomen was soft, and bowel sounds were normal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Laboratory tests were negative for influenza A and B viral antigens. The leukocyte count was 11.91<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L, with a neutrophil count of 2.91<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L (24.4%) and lymphocyte count of 7.87<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L (66.1%). The C-reactive protein level was 3.49<span class="elsevierStyleHsp" style=""></span>mg/L. The prothrombin time and <span class="elsevierStyleSmallCaps">d</span>-dimer level were normal, as well as alanine transaminase, alanine transaminase, urea nitrogen, and creatinine levels. Chest CT results had no abnormal findings (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Recombinant human interferon alfa-1b via atomization inhalation (20<span class="elsevierStyleHsp" style=""></span>µg, twice/day) was initiated.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Anal swabs were positive on February 27 and March 4. The symptoms improved on March 7, and anal swabs were negative on March 9 and 10. The patient was discharged on March 11. Throat swabs were persistently negative throughout the hospital stay. Real-time PCR for COVID-19 on pharyngeal and anal swabs were performed by the Pengzhou (Sichuan Province, China) CDC. The Chengdu CDC repeated the PCR testing and obtained the same results.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Diagnosis of SARS-CoV-2 depends on imaging, epidemiological history, and nucleic acid testing. During the early stage of the pandemic, most patients were in China, especially in Wuhan, Hubei Province.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> As the number of patients grew geometrically, the Chinese government locked down Wuhan and effectively isolated infected people from non-infected people. In early March 2020, the disease was effectively controlled in China.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9,10</span></a> However, many confirmed and suspected cases have appeared in other regions and countries.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> It has become a global pandemic, and its rapid spread and high lethality require special attention.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although the infection and mortality rates are lower in infants and young children than in adults,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> young patients cannot communicate effectively, which limits the ability to obtain their medical history. Our patient developed a sudden onset cough, and her mother was confirmed to be infected. Although the baby's pharyngeal swabs and chest CT were negative, her anal swabs remained positive for eight days.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Not enough attention is given to asymptomatic or mildly infected patients with positive anal swabs. Here, we present a mildly ill baby whose anal swabs were real-time PCR positive for SARS-CoV-2, while many pharyngeal swabs were negative. SARS-CoV-2 was stable under the conditions tested.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> The main host receptor is angiotensin converting enzyme 2, which is located on gastrointestinal epithelial cells, and the feces of 20% of SARS-CoV-2 patients remain positive for viral RNA after negative conversion of viral RNA in the respiratory tract.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Wang et al. detected live SARS-CoV-2 in stool samples from two confirmed patients.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Unfortunately, our laboratory lacked the capacity to determine whether the stool virus was still active.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Physicians should be aware that asymptomatic or mildly ill children with history of exposure and negative pharyngeal/nasal swabs and positive anal swabs are potential sources of infection via fecal–oral transmission for COVID-19. In addition to nasal/pharyngeal swabs, we believe that children should be tested for SARS-CoV-2 using anal swabs.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Infants with a history of SARS-CoV-2 exposure and mild symptoms should be tested using anal swabs.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical approval</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study was approved by Pidu District People's Hospital (Batch 2020-03-18-001).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">No founding.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study was a retrospective observational nature study, patient identity remained anonymous, and have no invasive procedure, so the ethics committee waived informed consent.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1375018" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1263096" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical approval" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Informed consent" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-03-20" "fechaAceptado" => "2020-04-20" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1263096" "palabras" => array:3 [ 0 => "Severe acute respiratory syndrome coronavirus 2" 1 => "Baby" 2 => "Anal swab" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China and has spread rapidly worldwide. We present a mild SARS-CoV-2 infection in a baby with non-productive cough and normal chest computed tomography, in whom only anal swabs tested positive by real-time PCR testing for SARS-CoV-2. She was given atomization inhalation therapy with recombinant human interferon alfa-1b for 10 days. Her anal swabs remained positive for eight days, whereas her throat swabs were persistently negative by real-time PCR testing. Mild and asymptomatic cases, especially in children, might present with PCR negative pharyngeal/nasal swabs and PCR positive anal swabs. Those patients are potential sources of infection via fecal–oral transmission for COVID-19.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 774 "Ancho" => 1500 "Tamanyo" => 198362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Normal chest CT findings at different sections: A and D, B and E, and C and F represent the same levels.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z. Wu" 1 => "J.M. McGoogan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2020.2648" "Revista" => array:3 [ "tituloSerie" => "JAMA" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9676687" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiologic characteristics of early cases with 2019 novel coronavirus (2019-nCoV) disease in Republic of Korea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 15 | 20 | 35 |
| 2024 September | 35 | 34 | 69 |
| 2024 August | 53 | 31 | 84 |
| 2024 July | 58 | 39 | 97 |
| 2024 June | 40 | 35 | 75 |
| 2024 May | 36 | 19 | 55 |
| 2024 April | 66 | 31 | 97 |
| 2024 March | 52 | 30 | 82 |
| 2024 February | 59 | 31 | 90 |
| 2024 January | 41 | 38 | 79 |
| 2023 December | 29 | 37 | 66 |
| 2023 November | 40 | 44 | 84 |
| 2023 October | 43 | 36 | 79 |
| 2023 September | 53 | 53 | 106 |
| 2023 August | 38 | 19 | 57 |
| 2023 July | 48 | 30 | 78 |
| 2023 June | 32 | 15 | 47 |
| 2023 May | 49 | 16 | 65 |
| 2023 April | 44 | 22 | 66 |
| 2023 March | 84 | 21 | 105 |
| 2023 February | 68 | 21 | 89 |
| 2023 January | 40 | 18 | 58 |
| 2022 December | 70 | 18 | 88 |
| 2022 November | 72 | 42 | 114 |
| 2022 October | 90 | 28 | 118 |
| 2022 September | 54 | 45 | 99 |
| 2022 August | 84 | 37 | 121 |
| 2022 July | 75 | 29 | 104 |
| 2022 June | 58 | 35 | 93 |
| 2022 May | 65 | 28 | 93 |
| 2022 April | 78 | 36 | 114 |
| 2022 March | 105 | 41 | 146 |
| 2022 February | 124 | 50 | 174 |
| 2022 January | 127 | 34 | 161 |
| 2021 December | 70 | 38 | 108 |
| 2021 November | 58 | 33 | 91 |
| 2021 October | 49 | 53 | 102 |
| 2021 September | 52 | 43 | 95 |
| 2021 August | 41 | 46 | 87 |
| 2021 July | 31 | 39 | 70 |
| 2021 June | 40 | 41 | 81 |
| 2021 May | 56 | 57 | 113 |
| 2021 April | 96 | 102 | 198 |
| 2021 March | 134 | 51 | 185 |
| 2021 February | 103 | 27 | 130 |
| 2021 January | 120 | 34 | 154 |
| 2020 December | 71 | 33 | 104 |
| 2020 November | 53 | 23 | 76 |
| 2020 October | 69 | 30 | 99 |
| 2020 September | 119 | 37 | 156 |
| 2020 August | 303 | 93 | 396 |
| 2020 July | 297 | 96 | 393 |
| 2020 June | 103 | 36 | 139 |
| 2020 May | 143 | 65 | 208 |
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