Tsutsugamushi Hepatopathy: A Scoping Review

Scrub typhus, caused by Orientia tsutsugamushi, is a significant public health concern, particularly in endemic regions of Asia. This mite-borne disease, transmitted by chiggers, presents with varied clinical manifestations, ranging from mild symptoms to severe complications, including multi-organ failure. Hepatic dysfunction is a common and often underappreciated clinical feature in scrub typhus patients, with recent studies highlighting its frequent occurrence. This dysfunction is characterized by elevated liver enzymes, jaundice, and, in severe cases, fulminant hepatic failure, often mimicking acute viral hepatitis. The pathophysiology of hepatic dysfunction is multifactorial, involving direct bacterial invasion, immune-mediated damage, and systemic inflammatory responses. Key mechanisms include focal or disseminated vasculitis and perivasculitis, endothelial dysfunction, and potential direct cytopathic effects on hepatocytes. Dysregulated cellular immunity, marked by a strong Th1 response, also contributes to tissue damage. Additionally, sepsis can lead to ischemic hepatitis and further hepatic dysfunction. A scoping review of 63 studies, predominantly from Asia, revealed varying incidences of hepatomegaly (2.5%-98.5%), jaundice (1.4%-36.5%), and abnormal transaminase levels (27.5%-100%). Hepatic dysfunction is typically hepatocellular, with AST often more elevated than ALT. While acute liver failure is rare, it is reported mostly in pediatric patients. Hepatic dysfunction correlates with overall disease severity and is associated with increased risks of delayed defervescence, prolonged hospitalization, other organ failures, and mortality in both adult and pediatric populations. Given its impact on patient outcomes, early recognition of hepatic involvement is crucial for effective management.