Liver involvement in systemic infection

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

NTCP: Na⁺/taurocholate cotransporting polypeptide; BSEP: Bile salt export pump; MRP2: Multidrug-resistance-associated protein 2.

Table 2 Foodbrone pathogens and manifestations

Pathogens	Manifestations
Bacteria
Staphylococcus aureus	Vomiting (exotoxin), toxic shock syndrome
Clostridium spp
C. botulinumC. perfringens	Neurogenic finding (paralysis) Diarrhea, gas gangrene, intravascular hemolysis, jaundice, liver abscess, gas in the portal vein
Campylobacter spp
C. jejuni	Inflammatory diarrhea, liver injury (possible)
C. fetus	Systemic, liver injury (possible)
Escherichia coli
Enterotoxigenic E. coli	Inflammatory diarrhea
Enterohemorrhagic E coli	Inflammatory diarrhea, hemolytic uremic syndrome
Listeria monocytogens	Systemic (Listeriosis), elevated aminotransferases
Salmonella spp
Non-typhoidal	Inflammatory diarrhea Systemic (Typhoid fever), acute hepatitis (Salmonella hepatitis)
S.typhiS.paratyphi
Shigella spp	Inflammatory diarrhea, cholestatic hepatitis
Vibrios spp
V. cholera	Watery diarrhea
V. parahemolyticus	Inflammatory diarrhea
V. vulnificus	Systemic (sepsis, DIC)
Yersina entrrocolitica	Inflammatory diarrhea, multiple liver abscesses
Virus
Hepatitis A	Acute hepatitis, jaundice
Hepatitis E	Acute hepatitis, jaundice
Norovirus	Vomiting, watery diarrhea
Rotavirus	Vomiting, watery diarrhea

Table 3 Frequency of symptoms and signs in salmonella and acute viral hepatitis A

	Nausea/vomiting	Abdominal discomfort	Jaundiceb	Diarrhea	Relativebradycardiad	Fever>104°Fb	Hepatomegaly	Splenomegaly
Salmonella hepatitis	70%	33%	33%	48%	37%	41%	44%	7%
Acute viral hepatitis A	89%	63%	89%	30%	4%	0%	66%	11%

Modified from El-Newihi et al[19]. Salmonella hepatitis vs acute viral hepatitis A:

^bP < 0.0001;

^dP < 0.002.

Table 4 Comparison of clinical features of hepatitis caused by various viruses

	n	Median age (range)	ALT (U/L)	ALP (U/L)	Bilirubin (μmol/L)	Lymphocyte count (× 109/L)	Lymphocytosis n (%)
EBV	17	40 (18-68)	395 (87-1362)	345 (160-756)	74 (13-165)	6.91 (3.77-24.82)	17 (100)
HAV	11	44 (20-61)	1056 (595-4122)	231 (91-342)	154 (42-214)	2.16 (1.23-4.1)	1 (9)
HBV	16	39 (20-60)	1858 (499-3856)	230 (93-406)	122 (36-355)	2.00 (1.26-3.52)	2 (12.5)
HEV	20	63 (54-81)	1387 (318-6357)	192 (139-464)	61 (8-297)	1.89 (0.96-10.25)	5 (25)

Modified from Vine et al[60]. EBV: Epstein-Barr virus; HAV: Hepatitis A virus; HBV: Hepatitis B virus; HEV: Hepatitis E virus.

Table 5 Parasitic infection of the liver

Disease (organism)	Organs/status	Clinical presentation
Malaria (P. falciparum, malariae, vivax, ovale)	Pre-erythrocytic phase	Asymptomatic
	Erythrocytic phase	Anemia, jaundice, mild elevation of aminotransferases, tender hepatomegaly, splenomegaly
Amebiasis (Entameba histolytica)	Intestine Amebic liver abscess	Right 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 Rupture	Asymptomatic 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 phase	Eosinophilic infiltrate Presinusoidal portal hypertension, splenomegaly, gastroesophageal varices
Fascioliasis (F. hepatica)	Acute phase Chronic phase	Abdominal pain, fever, hemobilia, hepatomegaly Biliary colic, cholangitis, cholelithiasis, obstructive jaundice
Ascariasis (A.lumbricoides)		Abdominal pain, fever, obstructive jaundice