Liver involvement in murine typhus |
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Authors: | Silpapojakul K; Mitarnun W; Ovartlarnporn B; Chamroonkul N; Khow-Ean U |
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Affiliation: | Department of Medicine and Pathology, Prince of Songkla University, Hat-Yai, Songkla 90112, Thailand; Corresponding author |
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Abstract: | Liver involvement was retrospectively evaluated in 137 patients with murine
typhus. Fifteen (10.9%) were jaundiced. One patient had been subjected to
cholecystectomy after misdiagnosis of acute cholecystitis. Serum
aminotransferase levels were abnormal in 48/52 measurements, and there were
elevations of >5-fold in 14 patients. Liver biopsies and/or
necropsies from four jaundiced patients showed portal tract and sinusoidal
infiltrates, cloudy swelling/and necrosis of the hepatocytes and occasional
pseudogranuloma formation. There were striking mitoses even in the early
stage, suggesting rapid hepatocellular regeneration. Haemolytic diseases
(G7PD deficiency or haemoglobinopathies), alcoholism, and a second
infection probably also contributed to the pathogenesis of jaundice in
murine typhus. This rickettsiosis should be included among differential
diagnoses of acute hepatitis in patients exposed to areas endemic for
<it>Rickettsia typhi</it>.
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