Selected Infections With Liver Involvement
Disease or Organism | Manifestations |
|---|---|
Viruses | |
In neonates: Hepatomegaly, jaundice, congenital defects In adults: Mononucleosis-like illness with hepatitis; may occur posttransfusion | |
Epstein-Barr virus infections | Clinical hepatitis with jaundice in 5–10%; subclinical liver involvement in 90–95% Acute hepatitis sometimes severe in young adults |
Mild aminotransferase elevation Direct infection of virus contributes to hepatic impairment Correlates with disease severity but can occur in asymptomatic infection as well | |
Anicteric hepatitis, usually in immunocompromised patients (but can also occur in immunocompetent patients) Fever in the majority; rash in 50% Acute hepatitis, often severe | |
Jaundice, systemic toxicity, bleeding Liver necrosis with little inflammatory reaction | |
Other | Hepatic infection occasionally due to echovirus or coxsackievirus infections, varicella, rubella, or rubeola |
Bacteria | |
Granulomatous reaction of liver with progressive necrotizing abscesses | |
Pyogenic abscess* | Serious infection acquired via portal pyemia, cholangitis, or hematogenous or direct spread; due to various organisms, especially gram-negative and anaerobic Illness and toxicity, yet only mild liver dysfunction |
Hepatic involvement (common, usually subclinical) with granulomatous infiltration; jaundice (rare) Disproportionately increased alkaline phosphatase | |
Other | Minor focal hepatitis in numerous systemic infections (common, usually subclinical) |
Fungi | |
Granulomas in liver and spleen (usually subclinical) that heal with calcification | |
Other | Granulomatous infiltration sometimes occurring in cryptococcosis, coccidioidomycosis, blastomycosis, or other infections |
Protozoa | |
Important disease, often without obvious dysentery Usually a large single abscess with liquefaction Systemic illness, tender hepatomegaly, surprisingly mild liver dysfunction | |
A common cause of hepatosplenomegaly in endemic areas Jaundice absent or mild unless active hemolysis is present | |
Transplacental infection In neonates: Jaundice, central nervous system (CNS) and other systemic manifestations | |
Infiltration of reticuloendothelial system by parasite, hepatosplenomegaly | |
Helminths | |
Biliary obstruction by adult worms, parenchymal granulomas caused by larvae | |
Biliary tract infestation, cholangitis, stones, cholangiocarcinoma | |
One or more hydatid cysts, which usually have a calcified rim and may be large but which often are asymptomatic and do not disrupt liver function Can rupture into the peritoneum or biliary tract | |
Acute: Tender hepatomegaly, fever, eosinophilia Chronic: Biliary fibrosis, cholangitis | |
Periportal granulomatous reaction to ova with progressive hepatosplenomegaly, pipestem fibrosis, portal hypertension, and varices Hepatocellular function preserved; not true cirrhosis | |
Visceral larva migrans syndrome Hepatomegaly with granulomas, eosinophilia | |
Spirochetes | |
Acute fever, prostration, jaundice, bleeding, renal injury Liver necrosis (often mild despite severe jaundice) | |
Congenital: Neonatal hepatosplenomegaly, fibrosis Acquired: Variable hepatitis in secondary stage, gummas with irregular scarring in tertiary stage | |
Borrelia infection Systemic symptoms, hepatomegaly, sometimes jaundice | |
* Differentiate from amebiasis with serologic tests for amebas and direct percutaneous abscess aspiration. | |