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| COMMENTARY |
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| Year : 2013 | Volume
: 6
| Issue : 4 | Page : 372-373 |
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Abnormal liver function in dengue: A topic to be considered
Viroj Wiwanitkit
Visiting Professor, Hainan Medical University, China; Visiting professor, Faculty of Medicine, University of Nis, Serbia; adjunct professor, Joseph Ayobabalola University,Nigeria
| Date of Web Publication | 17-Sep-2013 |
Correspondence Address:
Viroj Wiwanitkit
Professor, Wiwanitkit House, Bangkhae, Thailand-10160, Bangkok
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Wiwanitkit V. Abnormal liver function in dengue: A topic to be considered. Med J DY Patil Univ 2013;6:372-3 |
Dengue is an important tropical mosquito-borne infectious disease. This disease causes public health problems to several tropical endemic countries. Classically, this infection is defined as blood infection and the main clinical presentations include high fever (acute febrile illness), thrombocytopenia, and hemoconcentration.[1] Nevertheless, the pathogenic dengue virus can also cause other atypical clinical presentation. Of several organs that can be involved by dengue virus, liver is an important organ that gets several insults from dengue. Involvement of liver cells in dengue infection is confirmed,[2] and it is no doubt that liver abnormalities can be observed in dengue. According to a report from Thailand, an endemic country in Southeast Asia, the overall rate of liver dysfunction in dengue patients was 34.6%.[3] It was also observed that the rate of liver dysfunction among the patients with and without shock was not significantly different.[3] Nevertheless, it was reported that higher transaminase levels could be observed in the patients with more severe infection.[4] Of interest, some patients with abnormal liver function tests end up with hepatic encephalopathy and death.[3]
Hence, the concern on liver abnormality in any patient with dengue is needed. In the endemic areas of dengue where the high prevalence of other hepatitis virus infections can be seen, there are several considerations. First, dengue might have its first presentation as hepatitis and the diagnosis of dengue might be delayed.[3] Jagadishkumar et al. suggested that "Any child with fever, jaundice, and tender hepatomegaly in geographical areas where dengue is endemic, the diagnosis of dengue infection should be strongly considered."[5] Second, the concurrent infection between dengue and hepatitis virus infection might lead to a more severe disease. In a recent report from Vietnam, Trung et al. reported that "chronic co-infection with hepatitis B was associated with modestly but significantly increased levels of alanine aminotransferase."[6] Third, to correspond with the possible liver dysfunction, the liver function test should be a laboratory investigation to be included in management of any patient with dengue.[1] Finally, due to the fact that dengue presently expands its geographical pattern to non-endemic area, the concern on dengue and its hepatitis presentation should be kept in mind of all practitioners.[7]
| References | |  |
| 1. | Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8:841-5. 
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| 2. | Colpitts TM, Barthel S, Wang P, Fikrig E. Dengue virus capsid protein binds core histones and inhibits nucleosome formation in human liver cells. PLoS One 2011;6:e24365.
[PUBMED] |
| 3. | Wiwanitkit V. Liver dysfunction in Dengue infection: an analysis of the previously published Thai cases. J Ayub Med Coll Abbottabad 2007;19:10-2.
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| 4. | Pancharoen C, Rungsarannont A, Thisyakorn U. Hepatic dysfunction in dengue patients with various severity. J Med Assoc Thai 2002;85(Suppl 1):S298-301.
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| 5. | Jagadishkumar K, Jain P, Manjunath VG, Umesh L. Hepatic involvement in dengue Fever in children. Iran J Pediatr 2012;22:231-6.
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| 6. | Trung DT, Thao le TT, Hien TT, Hung NT, Vinh NN, Hien PT, et al. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg 2010;83:774-80.
[PUBMED] |
| 7. | Bowman S, Salgado C, DeWaay DJ. Dengue fever presenting with hepatitis. Am J Med Sci 2012;344:335-6.
[PUBMED] |
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