Liver function test abnormalities in murine typhus in Greece: a retrospective study of 165 cases

The aim of this study was to analyse data relating to the liver function profile during acute infection from murine typhus in the city of Chania in the island of Crete (Greece). A retrospective study of the files of all the cases with a diagnosis of murine typhus admitted to the Saint George General Hospital of Chania over a 15-year period (1993-2008) was performed. Variations in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels were recorded from three consecutive examined serum samples. A total of 165 patients were diagnosed with murine typhus during the above time period. Serum aminotransferase and lactate dehydrogenase were abnormal in most of the first examined samples. Remarkably on admission, serum levels of AST, ALT, and LDH recorded an increase above the cut-off point in 142 (86%), 114 (69%) and 136 (82.4%) patients respectively. More than two out of every ten patients presented hepatomegaly. In conclusion, liver dysfunction occurs frequently in patients with murine typhus. A high level of physicians' awareness is required for the liver biochemical abnormalities caused by this worldwide zoonotic disease, especially in endemic areas such as Greece.