Enteric fever: do elevated liver enzymes influence outcome?

Enteric fever is frequently associated with abnormal liver function tests [1,2], and can mimic other infections such as malaria and amoebiasis. Severe hepatic involvement with clinical features of acute hepatitis (i.e. typhoid hepatitis) is rare. We sought to compare the clinical and laboratory features and outcome of patients with enteric fever with and without biochemical liver abnormalities. From January 1995 to December 2003, 108 patients with blood culture positive enteric fever and in whom liver function tests were also available were identified. Data extracted from in-patient records included history and physical examination, and laboratory tests including complete blood counts, serum creatinine, malaria blood smear, blood culture, hepatitis A virus IgM antibody, hepatitis B surface antigen (HBsAg), hepatitis B core IgM, anti-HCV antibody, hepatitis E virus antibody, and liver function tests including bilirubin, alanine aminotransferase (ALT), and alkaline phosphatase. Other causes of hepatitis such as alcohol, medications, malaria, and viral hepatitis were excluded. Of 663 patients identified over the 8-year study period with blood cultures positive for either Salmonella typhi or S. paratyphi, 108 had at least one set of serum liver function tests. Seventy two (67%) patients had elevation of at least one liver-associated enzyme; 46 (64%) were males and the mean (± SD) patient age was 30 ± 13.4 years. Clinical and laboratory features and outcomes are summarised in the Table1 . Clinical features did not differ between groups. Enteric fever: do elevated liver enzymes influence outcome?