Publication:

Clinical spectrum and outcome of elevated serum transaminases in tropical infections among children aged one month to 18 years in an urban tertiary care centre: a prospective observational study

Background Tropical infections are common in our country and occur with a variable elevation of transaminases in a majority of them and they pose as a differential diagnosis to the viral infections affecting the liver including COVID-19 and complications like HLH and also paracetamol toxicity. Aim was to study the clinical profile and degree of elevation of liver enzymes in tropical infections in children aged one month to18 years.

Methods A prospective observational study of children from one month to 18 years of age with tropical infections in Mehta's multispeciality hospitals, Chennai, India between June 2017 and May 2019 was analyzed. Elevation of liver enzymes was categorized as mild (1-3 fold), moderate (3-20 fold) and severe (>20 fold).

Results Dengue was the most common infection in our study and the majority (49.07%), followed by enteric fever (78.06%), malaria (27.27%) and leptospirosis (25%), all had a mild elevation of SGOT. Severe elevation of SGOT was seen in 25% of leptospirosis and less than 10% in malaria and none with scrub typhus. SGPT elevation was severe in 50% of leptospirosis. Dengue shock syndrome had a severe elevation of transaminases.

Conclusions The most common infection was dengue and the majority had mild elevation and those with shock had a severe elevation of transaminases whereas shock was not a feature in leptospirosis even in severe elevation in our study. Though liver enzymes were very much elevated, children recovered without any residual liver damage.