Jaundice systemic infections

Organisms other than the viruses discussed earlier can cause acute liver infections, such as Leptospira icterohaemorrhagia, which causes Weil s disease, fungal infections caused by Candida species or aspergillosis, and schistosomiasis caused by trematodes. A number of systemic infections may also affect the liver, leading to jaundice, abnormal liver function tests or even acute liver failure. Table 3.6 lists some of the infective organisms that have been associated with liver disease. 

A 44-year-old HIV-1 infected woman from the Ivory Coast, who was taking stavudine, lamivudine, efavirenz, and pyrimethamine plus sulfadiazine for Toxoplasma encephalitis, developed a maculopapular rash on both arms. The sulfadiazine was withdrawn and clindamycin was added. Ten days later her condition had worsened. Her temperature was 40 C, pulse rate 137/minute, and respiratory rate 26/minute. She had a generalized maculopapular rash without mucosal involvement, moderate abdominal tenderness, hepatomegaly, jaundice, and bilateral crackles. Her white cell count was 16 x 10 /1 with 9% eosinophils and 51% lymphocytes. A chest X-ray showed moderate bilateral interstitial pneumonitis. All drugs were withdrawn and she was given intravenous methylprednisolone. The skin rash and aU systemic manifestations resolved within 1 week and HIV treatment was restarted uneventfully with lamivudine, stavudine, and nehinavir. 

Inflammatory conditions of the liver, in particular inflammatory hepatocellular cholestasis, are one of the most frequent causes of jaundice in the clinic. The major underlying denominator of this disorder is the inhibition of transporter expression and function by proinflammatory cytokines, which are either induced systemically or within the liver. Alcoholic hepatitis accounts for up to two-thirds of patients and is the most frequent trigger, followed by idiosyncratic drug reactions, sepsis or other extrahepatic bacterial infections, some variants of viral hepatitis, and total parenteral nutrition [95, 96]. 

Warm autoimmune haemolytic anaemia may be either idiopathic or secondary to chronic lymphocytic leukaemia, lymphomas, systemic lupus erythematosus, or other autoimmune disorders or infections. Warm autoantibodies are responsible for 48-70% of autoimmune haemolytic anaemia cases and may occur at any age due to the secondary causes, however, the incidence increases starting around 40 years of age. There is an approximate 2 1 female predilection, possibly due to the association with other autoimmune diseases. Warm autoimmune haemolytic anaemia presents as a haemolytic anaemia of varying severity. The symptoms are those of anaemia (i.e. weakness, dizziness, fatigue, pallor, oedema, and dyspnoea on exertion) and haemolysis (i.e. jaundice, dark urine, and splenomegaly). The laboratory evaluation shows a reduced... 

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