Liver Involvement in Leptospirosis

Liver involvement is a common feature of leptospirosis. It is variable from mild to severe hepatic dysfunction. Objective: to analyze liver involvement and to assess its prognostic value in leptospirosis. Materials and methods: We performed analysis of 100 consecutive leptospirosis cases treated in Clinic of Infectious Diseases at University Hospital – Pleven (1976-2015)(90 male, mean age 37±18 years, lethal outcome in 13%), followed by comparative analysis of group with liver involvement (n1=71) versus group without liver involvement (n2=29). Results: Fever (100%), hepatomegaly (92%), myalgia (86%), vomiting (84%), splenomegaly (74%), oliguria (69%), jaundice (63%), hypotension (49%), abdominal pain (41%), and hemorrhagic diathesis (37%) were the characteristic manifestations. Headache, myalgia, abdominal pain, oliguria, hemorrhagic diathesis, myocarditis, acute respiratory failure and pancreatitis had had a significantly higher prevalence in the group with liver involvement. Increased levels of total bilirubin (mean 157.8±71.5 μmol/L) with prevalent direct fraction, ASAT (mean 112±18 IU/L), ALAT (mean 96±78 IU/L), hypoproteinemia and hypoalbuminemia were the main laboratory parameters that expressed hepatic dysfunction. Conclusion: The most affected liver functions are bilirubin metabolism and protein synthesis. Liver involvement in leptospirosis is important factor for severity, in combination with acute renal failure has severe course and requires early diagnosis and prompt intensive treatment.