Clinical-epidemiological profile of confirmed cases of osteoarticular tuberculosis.

Introduction: tuberculosis (TB) remains a major cause of morbidity and mortality worldwide. The incidence of TB has increased since the 1980s. Given the increasing prevalence of TB worldwide, osteoarticular TB (OATB) is a significant health problem. Methods: retrospective study of a case series of hospitalized patients with confirmed OATB by culture or histopathological examination who were seen at a reference orthopedic hospital in São Paulo, Brazil, from 2014 to 2019. Results: thirty patients with confirmed bone and joint TB were seen from 2014 to 2019. The main sites of OATB were the spine (83.3 %) and the appendicular skeleton (26.7 %). Indication of surgical treatment was significantly related to the need for hospitalization ( p = 0.009 ) and the increased length of hospital stay ( p = 0.005 ). Presence of sequelae at the end of treatment was correlated with the presence of motor deficit at the time of OATB diagnosis ( p = 0.035 ) as well as with initial presence of functional limitation ( p = 0.025 ) and with high value of C-reactive protein at the end of treatment ( p = 0.037 ). Conclusions: the delay in the onset of clinical and laboratory signs of cases of osteoarticular infections hinders the early diagnosis and treatment of the disease, resulting in major complications sometimes requiring surgical treatment and consequently leading to a prolonged hospital stay, evidence of high inflammatory activities, and the presence of neurological deficits.

Orthopedic infections due to Trichosporon species: Case series and literature review.

Reports of orthopedic fungal infections caused by Trichosporon species are extremely scarce, thus we aimed to describe a case series and review the cases published in the literature. Patients were retrospectively included if a previous culture of bone, joint, or soft tissues had resulted positive for Trichosporon species along with a clinical diagnosis of an orthopedic infection. Eight patients were included with diverse orthopedic conditions, most of them cases of osteomyelitis. The main isolated species was Trichosporon asahii. All patients were treated with antifungals, mainly voriconazole, and surgical management, resulting in high rates of clinical improvement and low associated mortality.

Reports of orthopedic infections caused by Trichosporon species are scarce. We described a case series of orthopedic infections caused by Trichosporon species and reviewed the previous published cases in the literature. We observed a high rate of clinical improvement and a low associated mortality.

Bioactive glass S53P4 to fill-up large cavitary bone defect after acute and chronic osteomyelitis treated with antibiotic-loaded cement beads: A prospective case series with a minimum 2-year follow-up.

INTRODUCTION: Bioactive glass S53P4 (BAG-S53P4) has been used in the treatment of osteomyelitis with excellent results. The aim of this study was to evaluate the clinical and radiographic results of patients treated with use of antibiotic-loaded cement beads, followed by bone defects filling using bioglass. METHODS: We treated a prospective series of patients presenting with acute or chronic osteomyelitis of a long bone of the upper or lower limb. The first-stage procedure involved debridement and filling of cavitary defects with antibiotic-loaded polymethylmethacrylate (PMMA) beads. When signs of infection subsided, the defects were filled with BAG-S53P4. The main outcomes assessed were the reinfection rate, need for reoperation, radiographic and functional evaluations (DASH and Lysholm scores). RESULTS: Ten patients were included, aged between 4 and 66 years (mean 25.4 years). The source of infection was hematogenic in five cases and post-traumatic in the other five. Hematogenic infections required two debridements before filling with bioglass, whereas post-traumatic cases required only one. The time between the first debridement and the application of bioglass varied from 1 to 63 weeks (average of 17 weeks). All patients showed a favorable evolution after bioglass procedure, with no need for reoperation or relevant wound problems. The radiographic evaluation showed partial incorporation of the material and adequate bone formation, and functional scores were satisfactory in all cases. CONCLUSION: The treatment of osteomyelitis with surgical debridement and PMMA beads, followed by filling of bone defect with BAG-S53P4, was effective in all patients evaluated, with adequate infectious control and bone regeneration. No cases required reoperation after bioglass implantation. Patients with hematogenous osteomyelitis required a greater number of debridements before filling with bioglass.

Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention.

BACKGROUND: Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p < 0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p = 0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p < 0.05). CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.

Prosthetic joint infection due to Candida species: Case series and review of literature.

INTRODUCTION: The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS: Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS: For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS: Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES: After the initial management, 73% of the patients achieved clinical remission. CONCLUSION: The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS: Prosthetic joint infection, Candida, treatment, and diagnosis.

Septic arthritis of the knee: clinical and laboratory comparison of groups with different etiologies

OBJECTIVES: To clinically and epidemiologically characterize a population diagnosed with and treated for septic arthritis of the knee, to evaluate the treatment results and to analyze the differences between patients with positive and negative culture results, patients with Gram-positive and Gram-negative bacterial isolates and patients with S. aureus- and non-S. aureus-related infections. METHODS: One hundred and five patients with septic knee arthritis were included in this study. The clinical and epidemiological data were evaluated. Statistical analysis was performed to compare patients with and without an isolated causative agent, patients with Gram-positive and Gram-negative pathogens and patients with S. aureus-related and non S. aureus-related infections. RESULTS: Causative agents were isolated in 81 patients. Gram-positive bacteria were isolated in 65 patients and Gram-negative bacteria were isolated in 16 patients. The most commonly isolated bacterium was S. aureus. Comparing cases with an isolated pathogen to cases without an isolated pathogen, no differences between the studied variables were found except for the longer hospital stays of patients in whom an etiological agent was identified. When comparing Gram-positive bacteria with Gram-negative bacteria, patients with Gram-positive-related infections exhibited higher leukocyte counts. Patients with S. aureus-related infections were more frequently associated with healthcare-related environmental encounters. CONCLUSION: S. aureus is the most common pathogen of septic knee arthritis. Major differences were not observed between infections with isolated and non-isolated pathogens and between infections with Gram-positive and Gram-negative bacteria. S. aureus infections were more likely to be associated with a prior healthcare environment exposure.

The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures.

OBJECTIVE: To evaluate the incidence and microbiological profile of surgical site infections (SSIs) associated with internal fixation of fractures and to compare differences in the SSIs observed among patients with closed and open fractures. METHODS: Retrospective study. Analyzed data included information from all patients who underwent surgery for fixation of closed or open fractures from January 2005 to December 2012 and remained outpatients for at least one year following surgery. Incidence of surgical site infection (SSI) was compared between patients with closed and open infection, as well as polymicrobial infection and infection related to Gram-negative bacilli (GNB). Cumulative antibiograms were performed to describe microbiological profiles. RESULTS: Overall incidence of SSI was 6%. This incidence was significantly higher among patients with open fractures (14.7%) than among patients with closed fractures (4.2%). The proportions of patients with polymicrobial infections and infections due to GNB were also significantly higher among patients with open fractures. Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species were the primary infectious agents isolated from both groups. The overall incidence of MRSA (methicillin-resistant S. aureus) was 72%. A. baumannii was the predominant GNB isolate recovered from patients with open fractures and P. aeruginosa was the most frequent isolate recovered from patients with closed fractures, both exhibited low rates of susceptibility to carbapenems. CONCLUSIONS: Incidence of SSIs related to the internal fixation of fractures was significantly higher among patients with open fractures, indicating that an open fracture can be a risk factor for infection. Among the bacterial isolates, S. aureus (with a high prevalence of MRSA) and CoNS species were most prevalent. A. baumannii and P. aeruginosa isolates underscored the low rate of susceptibility to carbapenems that was observed in the present study.

OBJETIVO: Avaliar a incidência e o perfil microbiológico das ISC relacionadas a procedimentos de fixação de fraturas num hospital acadêmico ortopédico terciário em São Paulo, Brasil, e comparar as diferenças observadas entre os pacientes com fraturas fechadas e expostas. MÉTODOS: Estudo retrospectivo. Foram incluídos na análise os dados relativos a todos os pacientes que passaram por procedimento cirúrgico para fixação de fraturas fechadas ou expostas de janeiro de 2005 a dezembro de 2012 e que mantiveram seguimento por pelo menos um ano. Foi verificada a presença de associação entre o tipo de fratura, a incidência de ISC e as incidências de infecções polimicrobianas e por bacilos Gram-negativos. O perfil microbiológico foi estabelecido por meio da elaboração de antibiogramas cumulativos. RESULTADOS: A incidência geral de infecção de 6%. Essa incidência foi maior no grupo de pacientes com fraturas expostas (14,7%) do que naqueles com fraturas fechadas (4,2%), com diferença estatisticamente significante. O número de pacientes com infecções polimicrobianas e com infecções relacionadas a BGN também foi significativamente maior no grupo de casos relacionados a fraturas expostas. Staphylococcus aureus e espécies de Staphylococcus coagulase-negativo (CoNS) foram os principais agentes isolados nos dois grupos. A incidência de MRSA (S. aureus resistente a meticilina) dentre todos os isolados de S. aureus foi de 72%. A. baumannii foi o principal BGN isolado entre os pacientes com fraturas expostas e P. aeruginosa entre os pacientes com fraturas fechadas. Em ambos os casos, observaram-se baixos índices de sensibilidade a carbapenêmicos. CONCLUSÕES: A incidência de ISC relacionada à fixação interna de fraturas foi significantemente maior nos pacientes com fraturas expostas, o que indica que esse tipo de fratura pode ser um fator de risco para a ocorrência desse tipo de infecção. Dentre os isolados bacterianos, predominaram no geral S. aureus (com elevada prevalência de MRSA) e S. coagulase-negativo. Dentre os BGN, houve predomínio de A. baumanni também entre os isolados de pacientes com fraturas expostas e P. aeruginosa entre os isolados daqueles com fraturas fechadas.

The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures / Infecção de sítio cirúrgico após fixação de fraturas fechadas e expostas - Incidência e perfil microbiológico

ABSTRACT OBJECTIVE: To evaluate the incidence and microbiological profile of surgical site infections (SSIs) associated with internal fixation of fractures and to compare differences in the SSIs observed among patients with closed and open fractures. METHODS: Retrospective study. Analyzed data included information from all patients who underwent surgery for fixation of closed or open fractures from January 2005 to December 2012 and remained outpatients for at least one year following surgery. Incidence of surgical site infection (SSI) was compared between patients with closed and open infection, as well as polymicrobial infection and infection related to Gram-negative bacilli (GNB). Cumulative antibiograms were performed to describe microbiological profiles. RESULTS: Overall incidence of SSI was 6%. This incidence was significantly higher among patients with open fractures (14.7%) than among patients with closed fractures (4.2%). The proportions of patients with polymicrobial infections and infections due to GNB were also significantly higher among patients with open fractures. Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species were the primary infectious agents isolated from both groups. The overall incidence of MRSA (methicillin-resistant S. aureus) was 72%. A. baumannii was the predominant GNB isolate recovered from patients with open fractures and P. aeruginosa was the most frequent isolate recovered from patients with closed fractures, both exhibited low rates of susceptibility to carbapenems. CONCLUSIONS: Incidence of SSIs related to the internal fixation of fractures was significantly higher among patients with open fractures, indicating that an open fracture can be a risk factor for infection. Among the bacterial isolates, S. aureus (with a high prevalence of MRSA) and CoNS species were most prevalent. A. baumannii and P. aeruginosa isolates underscored the low rate of susceptibility to carbapenems that was observed in the present study.

RESUMO OBJETIVO: Avaliar a incidência e o perfil microbiológico das ISC relacionadas a procedimentos de fixação de fraturas num hospital acadêmico ortopédico terciário em São Paulo, Brasil, e comparar as diferenças observadas entre os pacientes com fraturas fechadas e expostas. MÉTODOS: Estudo retrospectivo. Foram incluídos na análise os dados relativos a todos os pacientes que passaram por procedimento cirúrgico para fixação de fraturas fechadas ou expostas de janeiro de 2005 a dezembro de 2012 e que mantiveram seguimento por pelo menos um ano. Foi verificada a presença de associação entre o tipo de fratura, a incidência de ISC e as incidências de infecções polimicrobianas e por bacilos Gram-negativos. O perfil microbiológico foi estabelecido por meio da elaboração de antibiogramas cumulativos. RESULTADOS: A incidência geral de infecção de 6%. Essa incidência foi maior no grupo de pacientes com fraturas expostas (14,7%) do que naqueles com fraturas fechadas (4,2%), com diferença estatisticamente significante. O número de pacientes com infecções polimicrobianas e com infecções relacionadas a BGN também foi significativamente maior no grupo de casos relacionados a fraturas expostas. Staphylococcus aureus e espécies de Staphylococcus coagulase-negativo (CoNS) foram os principais agentes isolados nos dois grupos. A incidência de MRSA (S. aureus resistente a meticilina) dentre todos os isolados de S. aureus foi de 72%. A. baumannii foi o principal BGN isolado entre os pacientes com fraturas expostas e P. aeruginosa entre os pacientes com fraturas fechadas. Em ambos os casos, observaram-se baixos índices de sensibilidade a carbapenêmicos. CONCLUSÕES: A incidência de ISC relacionada à fixação interna de fraturas foi significantemente maior nos pacientes com fraturas expostas, o que indica que esse tipo de fratura pode ser um fator de risco para a ocorrência desse tipo de infecção. Dentre os isolados bacterianos, predominaram no geral S. aureus (com elevada prevalência de MRSA) e S. coagulase-negativo. Dentre os BGN, houve predomínio de A. baumanni também entre os isolados de pacientes com fraturas expostas e P. aeruginosa entre os isolados daqueles com fraturas fechadas.

Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

Abstract Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.

Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.

Septic arthritis of the knee: clinical and laboratory comparison of groups with different etiologies.

OBJECTIVES:: To clinically and epidemiologically characterize a population diagnosed with and treated for septic arthritis of the knee, to evaluate the treatment results and to analyze the differences between patients with positive and negative culture results, patients with Gram-positive and Gram-negative bacterial isolates and patients with S. aureus- and non-S. aureus-related infections. METHODS:: One hundred and five patients with septic knee arthritis were included in this study. The clinical and epidemiological data were evaluated. Statistical analysis was performed to compare patients with and without an isolated causative agent, patients with Gram-positive and Gram-negative pathogens and patients with S. aureus-related and non S. aureus-related infections. RESULTS:: Causative agents were isolated in 81 patients. Gram-positive bacteria were isolated in 65 patients and Gram-negative bacteria were isolated in 16 patients. The most commonly isolated bacterium was S. aureus. Comparing cases with an isolated pathogen to cases without an isolated pathogen, no differences between the studied variables were found except for the longer hospital stays of patients in whom an etiological agent was identified. When comparing Gram-positive bacteria with Gram-negative bacteria, patients with Gram-positive-related infections exhibited higher leukocyte counts. Patients with S. aureus-related infections were more frequently associated with healthcare-related environmental encounters. CONCLUSION:: S. aureus is the most common pathogen of septic knee arthritis. Major differences were not observed between infections with isolated and non-isolated pathogens and between infections with Gram-positive and Gram-negative bacteria. S. aureus infections were more likely to be associated with a prior healthcare environment exposure.

Gram-negative osteomyelitis: clinical and microbiological profile.

INTRODUCTION: Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature. OBJECTIVES AND METHODS: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. RESULTS: Most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%), Acinetobacter baumannii (21%) e Pseudomonas aeruginosa (20%). Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii. CONCLUSION: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

Gram-negative osteomyelitis: clinical and microbiological profile

INTRODUCTION: Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature. OBJECTIVES AND METHODS: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. RESULTS: Most patients were men (63 percent), with median age of 42 years, affected by chronic osteomyelitis (43 percent) or acute osteomyelitis associated to open fractures (32 percent), the majority on the lower limbs (71 percent). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60 percent, relapse 19 percent, amputation 7 percent, and death 5 percent. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25 percent), Acinetobacter baumannii (21 percent) e Pseudomonas aeruginosa (20 percent). Susceptibility to carbapenems was about 100 percent for Enterobacter sp., 75 percent for Pseudomonas aeruginosa and 60 percent for Acinetobacter baumannii. CONCLUSION: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

[Severe hepatitis and jaundice during the evolution of dengue virus infection: case report]. / Hepatite grave e icterícia durante a evolução de infecção pelo vírus da dengue: relato de caso.

We describe the case of a female patient who presented a condition of dengue hemorrhagic fever that evolved with jaundice and significant coagulation abnormalities. Dengue was diagnosed through the presence of anti-dengue IgM antibodies (MAC-ELISA). This disease needs to be taken into consideration in the differential diagnosis for acute febrile jaundice.

Hepatite grave e icterícia durante a evolução de infecção pelo vírus da dengue: relato de caso / Severe hepatitis and jaundice during the evolution of dengue virus infection: case report

Apresentamos o caso de uma paciente do sexo feminino, que apresentou quadro de febre hemorrágica da dengue, evoluindo com icterícia e importantes alterações da coagulação. O diagnóstico de dengue foi realizado pela presença de anticorpos IgM antidengue (MAC-ELISA). Esta doença deveria ser considerada no diagnóstico diferencial das icterícias febris agudas.

We describe the case of a female patient who presented a condition of dengue hemorrhagic fever that evolved with jaundice and significant coagulation abnormalities. Dengue was diagnosed through the presence of anti-dengue IgM antibodies (MAC-ELISA). This disease needs to be taken into consideration in the differential diagnosis for acute febrile jaundice.