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Liver involvement in murine typhus

K Silpapojakul1, W Mitarnun, B Ovartlarnporn

  • 1Department of Medicine, Prince of Songkla University, Thailand.

QJM : Monthly Journal of the Association of Physicians
|August 1, 1996
PubMed
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Murine typhus can cause liver damage and jaundice in over 10% of patients. Early diagnosis is crucial, as liver involvement may mimic acute hepatitis, requiring consideration in endemic areas.

Area of Science:

  • Infectious Diseases
  • Hepatology
  • Rickettsial Infections

Background:

  • Murine typhus, a rickettsiosis caused by Rickettsia typhi, can present with diverse clinical manifestations.
  • Liver involvement in murine typhus is not well-characterized, necessitating further investigation.

Purpose of the Study:

  • To retrospectively evaluate the spectrum and frequency of liver involvement in patients diagnosed with murine typhus.
  • To identify clinical and pathological features associated with hepatic dysfunction in murine typhus.

Main Methods:

  • Retrospective analysis of 137 patients with confirmed murine typhus.
  • Review of clinical data, laboratory results (serum aminotransferases), and histopathological findings (liver biopsies/necropsies).

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Main Results:

  • Fifteen percent of patients (10.9%) presented with jaundice.
  • Abnormal serum aminotransferase levels were observed in 48/52 patients, with significant elevations in 14.
  • Histopathology revealed portal/sinusoidal infiltrates, hepatocellular necrosis, and rapid regeneration, suggesting a direct or indirect rickettsial effect.

Conclusions:

  • Liver involvement, including jaundice and elevated aminotransferases, is a significant manifestation of murine typhus.
  • Differential diagnosis of acute hepatitis in endemic areas should include murine typhus.
  • Factors like G6PD deficiency, alcoholism, and co-infections may contribute to jaundice severity.