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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus equi</span> is a Gram-positive&#44; Lancefield group C coccal bacterium that has a close genetic link to <span class="elsevierStyleItalic">Streptococcus zooepidemicus</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> of which it is thought to be a direct ancestor&#44; and is the cause of less than 2&#37; of all the group C streptococcal infections&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> It is a common pathogen in horses&#44; cows and dogs&#44; and can be isolated from the serous discharge of wounds&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus equi</span> infection has been documented in humans who are in direct or indirect contact with animals&#44; especially horses&#44; although in most cases&#44; the route of transmission has not been clarified&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report a case of septic arthritis caused by <span class="elsevierStyleItalic">Streptococcus equi</span> in a person who may have acquired the infection through a relative who was in contact with horses&#46; The patient was a 72-year-old woman who presented with a 4-day history of pain&#44; swelling and functional limitation in right knee&#46; She had had no injuries&#46; Her granddaughter was a veterinarian at a racetrack&#46; She had a temperature of 38&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; increased knee volume&#44; fixed flexion of 30&#176;&#44; erythema and local warmth&#46; There was no evidence of tegmental damage either in or around the knee&#46; Ultrasound showed degenerative changes in the knee&#44; a compressible anechoic area in both suprapatellar recesses associated with a marked proliferation of homogeneous synovial fluid &#40;SF&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and the power Doppler signal was 1&#43;&#47;3&#43;&#46; In the other knee&#44; only similar degenerative changes were observed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Arthrocentesis yielded 90<span class="elsevierStyleHsp" style=""></span>mL of synovial fluid with inflammatory features&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The results of laboratory tests included a leukocyte count of 16<span class="elsevierStyleHsp" style=""></span>000&#47;mm<span class="elsevierStyleSup">3</span> &#40;90&#37; neutrophils&#41;&#44; C-reactive protein level of 210<span class="elsevierStyleHsp" style=""></span>mg&#47;L and procalcitonin level of 1&#46;70<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46; In SF&#44; there were no signs of microorganisms&#44; the cell count was 20<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>cells&#47;mL&#44; and the glucose and protein concentrations were 30<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and 2&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; respectively&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient underwent surgical lavage and was admitted to the hospital&#44; and empirical treatment with ceftriaxone 2<span class="elsevierStyleHsp" style=""></span>g&#47;day and cloxacillin 500<span class="elsevierStyleHsp" style=""></span>mg&#47;6<span class="elsevierStyleHsp" style=""></span>h was begun&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As SF and peripheral blood cultures were positive for <span class="elsevierStyleItalic">Streptococcus equi</span>&#44; treatment was changed to 1&#44;200&#44;000<span class="elsevierStyleHsp" style=""></span>U&#47;day of penicillin G&#46; As the patient&#39;s fever and pain persisted&#44; surgical lavage was repeated 10 days after her admission&#46; The outcome was favorable and she was discharged after 5 weeks of intravenous therapy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus equi</span> is a pathogen that causes &#8220;strangles&#8221;&#44; a lymphoproliferative disease that can affect horses&#44; donkeys and cattle&#44; although subclinical infection has also been documented in dogs&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#44;5</span></a> This disease produces enlargement of the cervical lymph nodes and is associated with upper airway symptoms in animals&#46; The lymphocyte proliferation can produce skin necrosis and neck abscesses&#46; Both the serous discharges from abscesses and saliva of the diseased animal are sources of transmission to other animals or to humans&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#44;5&#8211;7</span></a> Infection in humans mediated by the consumption of dairy products from infected animals has also been documented&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although a number of cases of <span class="elsevierStyleItalic">Streptococcus equi</span> infection have been reported in humans&#44;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;10&#8211;13</span></a> septic arthritis is a highly uncommon finding&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#44;11&#44;14&#8211;16</span></a> Information on the epidemiological burden of this pathogen as the causative agent is not available&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A history involving a connection to horses&#44; as occurred in our patient&#44; has not been demonstrated in most of the case reports&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> However&#44; despite this link&#44; it was not possible to determine the mechanism that produced the infection&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus equi</span> infection responds favorably to treatment with penicillins&#44; although cases of drug resistance have been reported and the clinical course is variable&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Another interesting finding was the marked synovial proliferation&#44; which could hardly be attributed to the similar degenerative changes in both knees&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus equi</span> is an uncommon cause of arthritis due to group C streptococci that should be considered in the differential diagnosis of arthritis in a single joint in patients who are in contact with animals&#44; especially horses&#46; The clinical course is variable and&#44; although&#44; theoretically&#44; it is sensitive to beta-lactams&#44; antibiotic resistance has been documented&#46; Our patient also had a marked synovial proliferation and an increased procalcitonin level&#44; but the cellularity in SF was not consistent with joint infection&#46; This protein is a precursor of calcitonin&#44; and has been included as a key test in the diagnosis of inflammatory processes mediated by bacterial agents&#46; Its concentration increases within the first 6<span class="elsevierStyleHsp" style=""></span>h of the production of bacteremia&#44; and its specificity ranges between 91&#37; and 93&#37;&#44; depending on the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> A recent study demonstrated the value of procalcitonin in cases in which the suspicion of septic arthritis overlapped that of gout&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> It was this finding that&#44; despite the low cellularity of the SF&#44; induced us to continue to suspect septic arthritis&#46;</p></span>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of the fibronectin-binding protein FNE from <span class="elsevierStyleItalic">Streptococcus equi</span> subspecies equi with FNZ from <span class="elsevierStyleItalic">S&#46; equi</span> subspecies <span class="elsevierStyleItalic">zooepidemicus</span> reveals a major and conserved difference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Lindmark"
                            1 => "M&#46; Nilsson"
                            2 => "B&#46; Guss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/IAI.69.5.3159-3163.2001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Immun"
                        "fecha" => "2001"
                        "volumen" => "69"
                        "paginaInicial" => "3159"
                        "paginaFinal" => "3163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11292736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Group C streptococci in human infection&#58; a study of 308 isolates with clinical correlations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Barnham"
                            1 => "J&#46; Kerby"
                            2 => "R&#46;S&#46; Chandler"
                            3 => "Millar M&#46;R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Infect"
                        "fecha" => "1989"
                        "volumen" => "102"
                        "paginaInicial" => "379"
                        "paginaFinal" => "390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2737252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zoonotic transmission of <span class="elsevierStyleItalic">Streptococcus equi</span> subsp&#46; zooepidemicus from a dog to a handler"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Abbott"
                            1 => "E&#46; Acke"
                            2 => "S&#46; Khan"
                            3 => "E&#46;G&#46; Muldoon"
                            4 => "B&#46;K&#46; Markey"
                            5 => "M&#46; Pinilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1099/jmm.0.012930-0"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Med Microbiol"
                        "fecha" => "2010"
                        "volumen" => "59"
                        "paginaInicial" => "120"
                        "paginaFinal" => "123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19745031"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0026049515001560"
                          "estado" => "S300"
                          "issn" => "00260495"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transmission of <span class="elsevierStyleItalic">Streptococcus equi</span> subspecies zooepidemicus infection from horses to humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Pelkonen"
                            1 => "S&#46;B&#46; Lindahl"
                            2 => "P&#46; Suomala"
                            3 => "J&#46; Karhukorpi"
                            4 => "S&#46; Vuorinen"
                            5 => "I&#46; Koivula"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3201/121365"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Infect Dis"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "1041"
                        "paginaFinal" => "1048"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23777752"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Streptococcus zooepidemicus&#58;</span> an emerging canine pathogen"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Priestnall"
                            1 => "K&#46; Erles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Vet J Lond Engl 1997"
                        "fecha" => "2011"
                        "volumen" => "188"
                        "paginaInicial" => "142"
                        "paginaFinal" => "148"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A horse bite to remember"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;C&#46; Brouwer"
                            1 => "E&#46;S&#46; Kasanmoentalib"
                            2 => "F&#46;W&#46;J&#46; Opstelten"
                            3 => "A&#46; van der Ende"
                            4 => "D&#46; van de Beek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(10)60965-8"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2010"
                        "volumen" => "376"
                        "paginaInicial" => "1194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20888995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Streptococcus zooepidemicus</span> septic arthritis&#58; case report and review of group C streptococcal arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Collazos"
                            1 => "M&#46;J&#46; Echevarria"
                            2 => "R&#46; Ayarza"
                            3 => "J&#46; de Miguel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1992"
                        "volumen" => "15"
                        "paginaInicial" => "744"
                        "paginaFinal" => "746"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1420701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An outbreak of <span class="elsevierStyleItalic">Streptococcus equi</span> subspecies zooepidemicus associated with consumption of fresh goat cheese"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Kuusi"
                            1 => "E&#46; Lahti"
                            2 => "A&#46; Virolainen"
                            3 => "M&#46; Hatakka"
                            4 => "R&#46; Vuento"
                            5 => "L&#46; Rantala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2334-6-36"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "6"
                        "paginaInicial" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16504158"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outbreak of <span class="elsevierStyleItalic">Streptococcus equi</span> subsp&#46; zooepidemicus infections on the island of Gran Canaria associated with the consumption of inadequately pasteurized cheese"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Bordes-Ben&#237;tez"
                            1 => "M&#46; S&#225;nchez-O&#241;oro"
                            2 => "P&#46; Su&#225;rez-Bord&#243;n"
                            3 => "A&#46;J&#46; Garc&#237;a-Rojas"
                            4 => "J&#46;A&#46; Sa&#233;z-Nieto"
                            5 => "A&#46; Gonz&#225;lez-Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10096-006-0119-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Microbiol Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "242"
                        "paginaFinal" => "246"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16550347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Horse bacterium causes human pericardial and pleural effusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Behnes"
                            1 => "K&#46; Mashayekhi"
                            2 => "G&#46; Geginat"
                            3 => "M&#46; Borggrefe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s15010-010-0055-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infection"
                        "fecha" => "2010"
                        "volumen" => "38"
                        "paginaInicial" => "501"
                        "paginaFinal" => "504"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20941523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe <span class="elsevierStyleItalic">Streptococcus zooepidemicus</span> infection in a gardener"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;S&#46; Lee"
                            1 => "J&#46;R&#46; Dyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med J Aust"
                        "fecha" => "2004"
                        "volumen" => "180"
                        "paginaInicial" => "366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15059062"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spondylodiscitis secondary to <span class="elsevierStyleItalic">Streptococcus equi</span> subspecies zooepidemicus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Bhatia"
                            1 => "N&#46; Bhanot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MAJ.0b013e31822cf8a8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Sci"
                        "fecha" => "2012"
                        "volumen" => "343"
                        "paginaInicial" => "94"
                        "paginaFinal" => "97"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21825960"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Human infection with <span class="elsevierStyleItalic">Streptococcus zooepidemicus</span> &#40;Lancefield group C&#41;&#58; three case reports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Barnham"
                            1 => "A&#46; Ljunggren"
                            2 => "M&#46; McIntyre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Infect"
                        "fecha" => "1987"
                        "volumen" => "98"
                        "paginaInicial" => "183"
                        "paginaFinal" => "190"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3556445"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Group C streptococcal arthritis A case report of equine transmission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;W&#46; Gorman"
                            1 => "Collins D&#46;N&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Orthopedics"
                        "fecha" => "1987"
                        "volumen" => "10"
                        "paginaInicial" => "615"
                        "paginaFinal" => "616"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3575186"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute bacterial arthritis caused by group C streptococci"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; Gonz&#225;lez Ter&#225;n"
                            1 => "M&#46;P&#46; Roiz"
                            2 => "T&#46; Ruiz Jimeno"
                            3 => "J&#46; Rosas"
                            4 => "J&#46; Calvo-Al&#233;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2001"
                        "volumen" => "31"
                        "paginaInicial" => "43"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11503138"
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                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Pyogenic arthritis caused by streptococcus equisimilis &#40;group-C streptococcus&#41; in a patient with AIDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "C&#46; Galle"
                            2 => "M&#46; Struelens"
                            3 => "Y&#46; De Gheldre"
                            4 => "C&#46;M&#46; Farber"
                            5 => "T&#46; Appelboom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "1997"
                        "volumen" => "16"
                        "paginaInicial" => "314"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9184272"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Human bacterial arthritis caused by <span class="elsevierStyleItalic">Streptococcus zooepidemicus&#58;</span> report of a case"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Friederichs"
                            1 => "S&#46; Hungerer"
                            2 => "R&#46; Werle"
                            3 => "M&#46; Militz"
                            4 => "V&#46; B&#252;hren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2009.08.009"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "14"
                        "numero" => "Suppl&#46; 3"
                        "paginaInicial" => "e233"
                        "paginaFinal" => "e235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20004124"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procalcitonina&#58; una nueva herramienta diagn&#243;stica en la infecci&#243;n bacteriana"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "O&#46; Name Bayona"
                            1 => "A&#46; Fern&#225;ndez L&#243;pez"
                            2 => "C&#46; Luaces Cubells"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2002"
                        "volumen" => "119"
                        "paginaInicial" => "706"
                        "paginaFinal" => "714"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Valor de la procalcitonina en el diagn&#243;stico diferencial de la monoartritis microcristalina e infecciosa"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Guillen Astete"
                            1 => "C&#46; Medina Qui&#241;ones"
                            2 => "J&#46; Bachiller Corral"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2013"
                        "volumen" => "25"
                        "paginaInicial" => "237"
                        "paginaFinal" => "238"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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