Skip to main content
Log in

Liver and Tropical Infections

  • Review
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Tropical infections may present with primary hepatobiliary manifestations mimicking other liver diseases. Gastroenterologists and hepatologists practicing in endemic regions must be aware of appropriate diagnostic testing and treatment of these infections.

Recent Findings

Tropical infections like dengue, malaria, scrub typhus, and leptospirosis can mimic viral hepatitis, but certain subtle clues like ongoing fever after the onset of jaundice, hepatomegaly in the setting of acute liver failure-like presentation, preserved coagulation parameters, and multi-system involvement help in suspecting the diagnosis. Infections like localized hepatic tuberculosis, amebic liver abscess, and hydatid disease should be included in the differentials of space-occupying lesions in the liver parenchyma. Hepatosplenic schistosomiasis may mimic other causes of portal hypertension.

Summary

A high index of suspicion is required to include tropical infections in the differential diagnoses of patients with liver diseases. They are more likely to occur in individuals residing in the tropics, or with a travel history to these regions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Prahraj D, Anand AC. Tropical liver diseases: an overview. Clin Liver Dis. 2021;18:138–42. Seminal review discussing tropical liver diseases.

    Article  Google Scholar 

  2. Samanta J, Sharma V. Dengue and its effects on liver. World J Clin Cases. 2015;3:125–31.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kulkarni AV, Choudhury AK, Premkumar M, Jain P, Gupta E, Sarin SK. Spectrum, manifestations and outcomes of dengue infection in individuals with and without liver disease. J Clin Transl Hepatol. 2019;7:106–11.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Seneviratne SL, Malavige GN, de Silva HJ. Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg. 2006;100:608–14.

    Article  CAS  PubMed  Google Scholar 

  5. Devarbhavi H, Ganga D, Menon M, Kothari K, Singh R. Dengue hepatitis with acute liver failure: clinical, biochemical, histopathological characteristics and predictors of outcome. J Gastroenterol Hepatol. 2020;35:1223–8.

    Article  CAS  PubMed  Google Scholar 

  6. Jha AK, Nijhawan S, Rai RR, Nepalia S, Jain P, Suchismita A. Etiology, clinical profile, and inhospital mortality of acute-on-chronic liver failure: a prospective study. Indian J Gastroenterol. 2013;32:108–14.

    Article  PubMed  Google Scholar 

  7. Raafat N, Blacksell SD, Maude RJ. A review of dengue diagnostics and implications for surveillance and control. Trans R Soc Trop Med Hyg. 2019;113:653–60.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Galante A, Adeyi O, Lau L, Humar A, Galvin Z, Selzner N, et al. Liver transplantation for acute liver failure due to dengue fever. Hepatology. 2019;70:1863–5.

    Article  PubMed  Google Scholar 

  9. Izmirly AM, Alturki SO, Alturki SO, Connors J, Haddad EK. Challenges in dengue vaccines development: pre-existing infections and cross-reactivity. Front Immunol. 2020;11:1055. [cited 2023 Dec 31];11. Available from: https://pubmed.ncbi.nlm.nih.gov/32655548/

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Angelin M, Sjölin J, Kahn F, Ljunghill Hedberg A, Rosdahl A, Skorup P, et al. Qdenga® — a promising dengue fever vaccine; can it be recommended to non-immune travelers? Travel Med Infect Dis. 2023;54:102598.

    Article  CAS  PubMed  Google Scholar 

  11. • Anand AC, Puri P. Jaundice in malaria. J Gastroenterol Hepatol. 2005;20:1322–32. Important review article discussing the pathogenesis of liver involvement in malaria.

    Article  PubMed  Google Scholar 

  12. Murthy GL, Sahay RK, Sreenivas DV, Sundaram C, Shantaram V. Hepatitis in falciparum malaria. Trop Gastroenterol. 1998;19:152–4.

    CAS  PubMed  Google Scholar 

  13. Anand AC, Ramji C, Narula AS, Singh W. Malarial hepatitis: a heterogeneous syndrome? Natl Med J India. 1992;5:59–62.

    CAS  PubMed  Google Scholar 

  14. Bhalla A, Suri V, Singh V. Malarial hepatopathy. J Postgrad Med. 2006;52:315–20.

    CAS  PubMed  Google Scholar 

  15. Goljan J, Nahorski W, Felczak-Korzybska I, Górski J, Myjak P. Liver injury in the course of malaria. Int Marit Health. 2000;51:30–9.

    CAS  PubMed  Google Scholar 

  16. Joshi YK, Tandon BN, Acharya SK, Babu S, Tandon M. Acute hepatic failure due to Plasmodium falciparum liver injury. Liver. 1986;6:357–60.

    Article  CAS  PubMed  Google Scholar 

  17. Devarbhavi H, Alvares JF, Kumar KS. Severe falciparum malaria simulating fulminant hepatic failure. Mayo Clin Proc. 2005;80:355–8.

    Article  PubMed  Google Scholar 

  18. Ghoshal UC, Somani S, Chetri K, Akhtar P, Aggarwal R, Naik SR. Plasmodium falciparum and hepatitis E virus co-infection in fulminant hepatic failure. Indian J Gastroenterol. 2001;20:111.

    CAS  PubMed  Google Scholar 

  19. Treatment of severe malaria — UpToDate [Internet]. [cited 2023 May 6]. Available from: https://www.uptodate.com/contents/treatment-of-severe-malaria?search=treatment%20of%20complicated%20malaria&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

  20. Levett PN. Leptospirosis. Clin Microbiol Rev. 2001;14:296–326.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Moola S, Beri D, Salam A, Jagnoor J, Teja A, Bhaumik S. Leptospirosis prevalence and risk factors in India: evidence gap maps. Trop Doct. 2021;51:415–21.

    Article  PubMed  Google Scholar 

  22. Gupta N, Wilson W, Ravindra P. Leptospirosis in India: a systematic review and meta-analysis of clinical profile, treatment and outcomes. Infez Med. 2023;31:290–305.

    PubMed  PubMed Central  Google Scholar 

  23. De Brito T, da Silva AMG, Abreu PAE. Pathology and pathogenesis of human leptospirosis: a commented review. Rev Inst Med Trop Sao Paulo. 2018;60:e23.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wysocki J, Liu Y, Shores N. Leptospirosis with acute liver injury. Proc (Bayl Univ Med Cent). 2014;27:257–8.

    PubMed  PubMed Central  Google Scholar 

  25. Philip N, Affendy NB, Masri SN, Yuhana MY, Than LTL, Sekawi Z, et al. Combined PCR and MAT improves the early diagnosis of the biphasic illness leptospirosis. PLoS One. 2020;15:e0239069.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Luce-Fedrow A, Lehman ML, Kelly DJ, Mullins K, Maina AN, Stewart RL, et al. A review of scrub typhus (Orientia tsutsugamushi and related organisms): then, now, and tomorrow. Trop Med Infect Dis. 2018;3:8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gaba S, Gaba N, Gupta M, Sharma S. Hepatic and renal profile of scrub typhus patients at a tertiary care center in India. Cureus. 2020;12:e7925.

  28. Rathi P, Siddiqui KA, Shah P. Scrub typhus-related hepatotoxicity: the Indian scenario. Trop Doct. 2021;51:228–31.

    Article  PubMed  Google Scholar 

  29. Kanno A, Yamada M, Murakami K, Torinuki W. Liver involvement in Tsutsugamushi disease. Tohoku J Exp Med. 1996;179:213–7.

    Article  CAS  PubMed  Google Scholar 

  30. Chung J-H, Lim S-C, Yun N-R, Shin S-H, Kim C-M, Kim D-M. Scrub typhus hepatitis confirmed by immunohistochemical staining. World J Gastroenterol. 2012;18:5138–41.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gaba S, Sharma S, Gaba N, Gupta M. Scrub typhus leading to acute liver failure in a pregnant patient. Cureus. 2020;12:e10191.

  32. Pongponratn E, Maneerat Y, Chaisri U, Wilairatana P, Punpoowong B, Viriyavejakul P, et al. Electron-microscopic examination of Rickettsia tsutsugamushi-infected human liver. Trop Med Int Health. 1998;3:242–8.

    Article  CAS  PubMed  Google Scholar 

  33. Koh GCKW, Maude RJ, Paris DH, Newton PN, Blacksell SD. Diagnosis of scrub typhus. Am J Trop Med Hyg. 2010;82:368–70.

    Article  PubMed  PubMed Central  Google Scholar 

  34. •• Varghese GM, Dayanand D, Gunasekaran K, Kundu D, Wyawahare M, Sharma N, et al. Intravenous doxycycline, azithromycin, or both for severe scrub typhus. N Engl J Med. 2023;388:792–803. Recent randomised controlled trial from India showing superioriy of combination of doxycycline and azithromycin for severe scrub typhus.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. . Alvarez SZ. Hepatobiliary tuberculosis. J Gastroenterol Hepatol. 1998;13:833–9. Seminal review article discussing the myriad presentations of tubercular liver involvement.

    Article  CAS  PubMed  Google Scholar 

  36. Elhence A, Shalimar. Hepatic tuberculosis: a wolf in sheep’s clothing. J Clin Exp Hepatol. 2021;11:521.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Chaudhary P. Hepatobiliary tuberculosis. Ann Gastroenterol. 2014;27:207–11.

    PubMed  PubMed Central  Google Scholar 

  38. Alvarez SZ, Sollano JD. ERCP in hepatobiliary tuberculosis. Gastrointest Endosc. 1998;47:100–4.

    CAS  PubMed  Google Scholar 

  39. Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, et al. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. Indian J Med Res. 2017;145:448–63.

    PubMed  PubMed Central  Google Scholar 

  40. Dhiman RK, Saraswat VA, Rajekar H, Reddy C, Chawla YK. A guide to the management of tuberculosis in patients with chronic liver disease. J Clin Exp Hepatol. 2012;2:260–70.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hughes MA, Petri WA. Amebic liver abscess. Infect Dis Clin. 2000;14:565–82.

    Article  CAS  Google Scholar 

  42. Kumar R, Priyadarshi RN, Anand U. Management of ruptured amoebic liver abscess: can we afford surgical drainage today? Frontline Gastroenterol. 2020;12:695.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Sharma MP, Dasarathy S, Verma N, Saksena S, Shukla DK. Prognostic markers in amebic liver abscess: a prospective study. Am J Gastroenterol. 1996;91:2584–8.

    CAS  PubMed  Google Scholar 

  44. Noordin R, Yunus MH, Saidin S, Mohamed Z, Fuentes Corripio I, Rubio JM, et al. Multi-laboratory evaluation of a lateral flow rapid test for detection of amebic liver abscess. Am J Trop Med Hyg. 2020;103:2233–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Pandey S, Gupta GK, Wanjari SJ, Nijhawan S. Comparative study of tinidazole versus metronidazole in treatment of amebic liver abscess: a randomized control trial. Indian J Gastroenterol. 2018;37:196–201.

    Article  PubMed  Google Scholar 

  46. Sharma MP, Rai RR, Acharya SK, Ray JC, Tandon BN. Needle aspiration of amoebic liver abscess. BMJ. 1989;299:1308–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Kumar R, Ranjan A, Narayan R, Priyadarshi RN, Anand U, Null S. Evidence-based therapeutic dilemma in the management of uncomplicated amebic liver abscess: a systematic review and meta-analysis. Indian J Gastroenterol. 2019;38:498–508.

    Article  PubMed  Google Scholar 

  48. Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet. 1990;335:1503–6.

    Article  CAS  PubMed  Google Scholar 

  49. •• Khuroo MS, Rather AA, Khuroo NS, Khuroo MS. Hepatobiliary and pancreatic ascariasis. World J Gastroenterol. 2016;22:7507–17. Important review article discussing hepatobiliary ascariasis.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Khuroo MS, Zargar SA, Mahajan R, Bhat RL, Javid G. Sonographic appearances in biliary ascariasis. Gastroenterology. 1987;93:267–72.

    Article  CAS  PubMed  Google Scholar 

  51. Hashmi MA, De JK. Biliary ascariasis on magnetic resonance cholangiopancreatography. J Glob Infect Dis. 2009;1:144–5.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Epidemiology and control of echinococcosis — UpToDate [Internet]. [cited 2023 May 7]. Available from: https://www.uptodate.com/contents/epidemiology-and-control-of-echinococcosis?search=echinococcosis&topicRef=5669&source=see_link

  53. Echinococcosis: clinical manifestations and diagnosis — UpToDate [Internet]. [cited 2023 May 7]. Available from: https://www.uptodate.com/contents/echinococcosis-clinical-manifestations-and-diagnosis?search=echinococcosis&source=search_result&selectedTitle=1~55&usage_type=default&display_rank=1

  54. • Khuroo MS. Percutaneous drainage in hepatic hydatidosis—the PAIR technique: concept, technique, and results. J Clin Exp Hepatol. 2021;11:592–602. Seminal review discussing the evolution of the technique of PAIR for hydatid disease.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Frider B, Larrieu E, Odriozola M. Long-term outcome of asymptomatic liver hydatidosis. J Hepatol. 1999;30:228–31.

    Article  CAS  PubMed  Google Scholar 

  56. Ozaslan E, Bayraktar Y. Endoscopic therapy in the management of hepatobiliary hydatid disease. J Clin Gastroenterol. 2002;35:160–74.

    Article  PubMed  Google Scholar 

  57. Gogia N, Sharma R, Gamangatti S, Seenu V, Madhusudhan KS, Parshad R. Hepatic hydatid cysts with biliary, and peritoneal rupture and transdiaphragmatic migration. Trop Gastroenterol. 2006;27:93–6.

    PubMed  Google Scholar 

  58. Khuroo MS, Dar MY, Yattoo GN, Zargar SA, Javaid G, Khan BA, et al. Percutaneous drainage versus albendazole therapy in hepatic hydatidosis: a prospective, randomized study. Gastroenterology. 1993;104:1452–9.

    Article  CAS  PubMed  Google Scholar 

  59. Khuroo MS, Wani NA, Javid G, Khan BA, Yattoo GN, Shah AH, et al. Percutaneous drainage compared with surgery for hepatic hydatid cysts. N Engl J Med. 1997;337:881–7.

    Article  CAS  PubMed  Google Scholar 

  60. Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114:1–16.

    Article  PubMed  Google Scholar 

  61. Biswas SN, Kulkarni A, Jain M, Chaudhary N, Ghoshal UC. Intra-biliary rupture of hepatic hydatid cyst: an uncommon presentation of a common disease. Indian J Gastroenterol. 2021;40:445–7.

    Article  PubMed  Google Scholar 

  62. McManus DP, Dunne DW, Sacko M, Utzinger J, Vennervald BJ, Zhou X-N. Schistosomiasis. Nat Rev Dis Primers. 2018;4:13.

    Article  PubMed  Google Scholar 

  63. Kali A. Schistosome infections: an Indian perspective. J Clin Diagn Res. 2015;9:DE01–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Gray DJ, Ross AG, Li Y-S, McManus DP. Diagnosis and management of schistosomiasis. BMJ. 2011;342:d2651.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

Credit Authorship statement: AE: Writing original draft, review and editing. S: Writing original draft, review and editing, visualization and conception

Corresponding author

Correspondence to Shalimar.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elhence, A., Shalimar Liver and Tropical Infections. Curr Hepatology Rep (2024). https://doi.org/10.1007/s11901-024-00648-5

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11901-024-00648-5

Keywords

Navigation