Review
Copyright ©2014 Baishideng Publishing Group Inc.
World J Hepatol. Sep 27, 2014; 6(9): 632-642
Published online Sep 27, 2014. doi: 10.4254/wjh.v6.i9.632
Table 1 Mechanism of Jaundice in Sepsis
Increased bilirubin load
Hemolysis
Red blood cells lysed by bacterial products (e.g., exotoxin)
Red blood cells lysed by immunological mechanisms
Hepatic dysfunction
Hepatocellular injury (hepatitis and/or necrosis)
Hepatic ischemia
Decreased bilirubin uptake; dysfunction of basolateral transport (e.g., NTCP)
Decreased transport of conjugated bilirubin; dysfunction of canalicular transport (e.g., BSEP, MRP2)
Decreased bile flow
Table 2 Foodbrone pathogens and manifestations
PathogensManifestations
Bacteria
Staphylococcus aureusVomiting (exotoxin), toxic shock syndrome
Clostridium spp
C. botulinumC. perfringensNeurogenic finding (paralysis) Diarrhea, gas gangrene, intravascular hemolysis, jaundice, liver abscess, gas in the portal vein
Campylobacter spp
C. jejuniInflammatory diarrhea, liver injury (possible)
C. fetusSystemic, liver injury (possible)
Escherichia coli
Enterotoxigenic E. coliInflammatory diarrhea
Enterohemorrhagic E coliInflammatory diarrhea, hemolytic uremic syndrome
Listeria monocytogensSystemic (Listeriosis), elevated aminotransferases
Salmonella spp
Non-typhoidalInflammatory diarrhea Systemic (Typhoid fever), acute hepatitis (Salmonella hepatitis)
S.typhiS.paratyphi
Shigella sppInflammatory diarrhea, cholestatic hepatitis
Vibrios spp
V. choleraWatery diarrhea
V. parahemolyticusInflammatory diarrhea
V. vulnificusSystemic (sepsis, DIC)
Yersina entrrocoliticaInflammatory diarrhea, multiple liver abscesses
Virus
Hepatitis AAcute hepatitis, jaundice
Hepatitis EAcute hepatitis, jaundice
NorovirusVomiting, watery diarrhea
RotavirusVomiting, watery diarrhea
Table 3 Frequency of symptoms and signs in salmonella and acute viral hepatitis A
Nausea/vomitingAbdominal discomfortJaundicebDiarrheaRelativebradycardiadFever>104°FbHepatomegalySplenomegaly
Salmonella hepatitis70%33%33%48%37%41%44%7%
Acute viral hepatitis A89%63%89%30%4%0%66%11%
Table 4 Comparison of clinical features of hepatitis caused by various viruses
nMedian age (range)ALT (U/L)ALP (U/L)Bilirubin (μmol/L)Lymphocyte count (× 109/L)Lymphocytosis n (%)
EBV1740 (18-68)395 (87-1362)345 (160-756)74 (13-165)6.91 (3.77-24.82)17 (100)
HAV1144 (20-61)1056 (595-4122)231 (91-342)154 (42-214)2.16 (1.23-4.1)1 (9)
HBV1639 (20-60)1858 (499-3856)230 (93-406)122 (36-355)2.00 (1.26-3.52)2 (12.5)
HEV2063 (54-81)1387 (318-6357)192 (139-464)61 (8-297)1.89 (0.96-10.25)5 (25)
Table 5 Parasitic infection of the liver
Disease (organism)Organs/statusClinical presentation
Malaria (P. falciparum, malariae, vivax, ovale)Pre-erythrocytic phaseAsymptomatic
Erythrocytic phaseAnemia, jaundice, mild elevation of aminotransferases, tender hepatomegaly, splenomegaly
Amebiasis (Entameba histolytica)Intestine Amebic liver abscessRight upper quadrant pain, fever, hepatomegaly (50%), jaundice (< 10%)
Cystic echinococcosis (Echinococcus granulosus)Single cyst (> 70%), < 10 cm and no complication Size up (1-5 cm/year), > 10 cm RuptureAsymptomatic Abdominal pain, mass effect (possible) Peritonitis, hypersensitivity reactions
Alveolar echinococcus (E. multilocularis)Malaise, tender hepatomegaly, eosinophilia, obstructive jaundice, portal hypertension
Schitosomiasis (S. mansoni, japonicum)Acute phase Chronic phaseEosinophilic infiltrate Presinusoidal portal hypertension, splenomegaly, gastroesophageal varices
Fascioliasis (F. hepatica)Acute phase Chronic phaseAbdominal pain, fever, hemobilia, hepatomegaly Biliary colic, cholangitis, cholelithiasis, obstructive jaundice
Ascariasis (A.lumbricoides)Abdominal pain, fever, obstructive jaundice