Liver and Tropical Infections

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.

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.

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.