Jaundice in typhoid hepatitis: a light and electron microscopy study based on liver biopsies

Light and electron microscopy study of fourteen liver biopsies in typhoid fever disclosed a mild hepatitis in which there is marked reticulo-endothelial hyperplasia, with many lymphoid cells in the hepatic sinusoids. The hepatic cell lesion was non specific, manifested by reticulum endoplasmic dilatation, mitochondrial alteration and biliary canaliculus injury. Such findings were particularly evident in the jaundiced patients. Jaundice was, in our series, a more frequent complication of acute typhoid fever than commonly reported. Usually it is of short duration and the serum bilirubin was not markedly elevated. However, there were instances when the jaundice was so accentuated as to lead the clinician to a first diagnosis of virus hepatitis or leptospirosis. The pathogenesis of the intrahepatic cholestasis in typhoid fever is still obscure, but apparently it is, as has been described in other infectious diseases, due to an injury of the bile secretory apparatus brought out by the bacillary endotoxin.