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Interpreting Liver Function Abnormalities in Returned Travelers: Clinical Context Matters More Than Pathogen-Specific
Bouchra Lachhab1, Perry J van Genderen2,1
1Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Rotterdam, NLD.
Cureus
|June 22, 2026
Summary
Liver function test abnormalities (LFTA) are common in ill travelers but often non-specific. Clinical presentation provides more diagnostic insight than broad etiologic categories for interpreting liver involvement.
Area of Science:
- Tropical Medicine
- Hepatology
- Infectious Diseases
Background:
- Liver function test abnormalities (LFTA) are frequently observed in ill-returned travelers.
- The diagnostic value of LFTA in this population remains uncertain.
Purpose of the Study:
- To evaluate the associations between clinical presentation, etiologic categories, and LFTA in ill-returned travelers.
- To determine the diagnostic utility of LFTA in identifying specific pathogens.
Main Methods:
- Retrospective cohort study of 2,957 ill-returned travelers.
- Analysis of clinical presentation, broad etiologic categories (viral, bacterial, parasitic), and LFTA (presence, severity, type).
- Statistical evaluation using chi-square analysis, Cramér's V, and standardized residuals.
Main Results:
- LFTA were present in 40% of patients, predominantly mild with a mixed biochemical pattern.
- Clinical presentation strongly correlated with LFTA presence, severity, and type; febrile illness was linked to more severe LFTA.
- Broad etiologic categories showed associations with LFTA presence and severity but not a meaningful biochemical pattern association.
Conclusions:
- LFTA are prevalent but mainly non-specific in returning travelers.
- Clinical presentation offers more diagnostic insight into liver involvement than broad etiologic classifications.
- LFTA should be interpreted within the clinical context rather than as specific pathogen indicators.
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