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37 - Bacterial, Parasitic, and Fungal Infections of the Liver
- from SECTION V - OTHER CONDITIONS AND ISSUES IN PEDIATRIC HEPATOLOGY
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- By Donald A. Novak, M.D., Professor of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Florida College of Medicine, Shands AGH Children's Hospital, Gainesville, Florida, Gregory Y. Lauwers, M.D., Associate Professor of Pathology, Department of Pathology, Harvard Medical School, Boston, Massachusetts; Director of Gastrointestinal Pathology, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, Richard L. Kradin, M.D., Associate Professor, Department of Pathology, Harvard Medical School, Boston, Massachusetts; Associate Pathologist and Physician, Departments of Pathology and Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
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- Book:
- Liver Disease in Children
- Published online:
- 18 December 2009
- Print publication:
- 07 May 2007, pp 871-896
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- Chapter
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Summary
Both systemic and local infections caused by bacterial, fungal, and parasitic agents may cause significant hepatic dysfunction. This chapter attempts to delineate clinical syndromes caused by some of these organisms in the pediatric patient.
BACTERIAL INFECTIONS
Hyperbilirubinemia Associated with Sepsis
Although jaundice in association with bacterial sepsis may occur in adult patients, it appears to be significantly more common during infancy. Historically, infections of the urinary tract predominate; however, sepsis originating from other sites may contribute [1–4]. Accordingly, gram-negative bacilli, and especially Escherichia coli, are responsible for the majority of cases, although gram-positive organisms have been associated. Abnormal liver chemistries are found in approximately 50% of premature neonates with gram-negative bacteremia [5]. Clinical and laboratory manifestations are primarily those of the underlying disease state. Hyperbilirubinemia may be marked, with the direct fraction predominant [1]. Alkaline phosphatase levels are often elevated, and serum aminotransferase values remain normal or minimally increased [6, 7]. Hepatic biopsy usually demonstrates canalicular cholestasis, with minimal evidence of hepatocyte damage or inflammatory response [6] (Figure 37.1). On occasion, the biopsy may demonstrate prominent acute cholangitis with portal bile ductular proliferation, pathologic changes often seen in large bile duct obstruction. In these cases, the possibility of large duct obstruction must be excluded by ultrasound or endoscopic retrograde cholangiopancreatography (ERCP). Jaundice resolves with appropriate treatment of the underlying infection; duration of jaundice may vary from several days to several weeks.