Hepatic Dysfunction in Pediatric Scrub Typhus: Role of Liver Function Test in Diagnosis and Marker of Disease Severity
Chulapong Chanta MD*, Krilerk Triratanapa MD*, Preecha Ratanasirichup MD*, Warangkana Mahaprom MSN**
Affiliation : * Pediatric Unit, Chiang Rai Regional Hospital, Chiang Rai ** Nursing Unit, Chiang Rai Regional Hospital, Chiang Rai
Objective : Determine the frequency of abnormalities of liver function test in children with scrub typhus and its
relation with severity of disease.
Materials and Methods : Fifty-four children diagnosed with scrub typhus at Chiang Rai Regional Hospital from
January 2004 to December 2005 were studied. The diagnosis of scrub typhus in the present study was based
on a single indirect immunofluorescent antibody (IFA) titer against O tsutsugamushi of > 1:400 or a four fold
or greater rise in IFA titer to at least 1:200. Liver function tests (LFT) were done on the first few days of
admission in all patients. Abnormalities of LFT were focused on serum AST, ALT, albumin and total bilirubin
level. All of the patients were divided into two groups based on the presence or absence of complications.
Results : Fifty-two patients (96.3%) had abnormal LFT. Evaluation of aspartate aminotransferase (AST) and
alanine aminotransferase (ALT) were detected in 52 (96.3%) and 36 (66.7%) cases, respectively. Hypoalbu-
minemia and hyperbilirubinemia were detected in 23 (42.6%) and 4 (7.4%) cases, respectively. The higher
level of AST, ALT, and lower level of serum albumin correlated significantly with the severity of scrub typhus in
children.
Conclusion : Hepatic dysfunction is common in children with scrub typhus. Elevation of AST level may be used
as a screening test for diagnosis of scrub typhus in areas where rapid diagnostic test is not commercially
available. Increased AST, ALT, and hypoalbuminemia related with severity of disease.
Keywords : Hepatic dysfunction, Liver function test, Pediatric scrub typhus
