SALMONELLA HEPATITIS - ANALYSIS OF 27 CASES AND COMPARISON WITH ACUTEVIRAL-HEPATITIS

The liver is commonly involved in patients with typhoid fever. However , severe hepatic derangement simulating acute viral hepatitis is rare. Our aim was to characterize the clinical picture, biochemical feature s, and prognosis of Salmonella hepatitis. Retrospective case-control a nalysis of medical records included 27 patients with Salmonella hepati tis and 27 inpatients with acute viral hepatitis from 1973 to 1993. Tr avel history, clinical picture, a standard battery of 18 biochemical t ests, complete blood counts, disease complications, duration of hospit al admission, and final outcome were analyzed. Eleven patients with Sa lmonella hepatitis (40%) travelled abroad within 1 month of illness. A greater proportion of Salmonella hepatitis patients developed fever > 104 degrees (44% vs. 4%, respectively; P < .0001), and had relative b radycardia (42% vs. 4%, respectively; P < .002) than viral hepatitis p atients. Salmonella hepatitis was associated with lower peak serum ala nine transaminase (ALT), aspartate transaminase, and higher peak serum alkaline phosphatase (296 vs. 3,234 U/L, 535 vs. 2,844 U/L, and 500 v s. 228 U/dL, respectively; P < .0001, < .0003, and < .004). The admiss ion ALT/lactic dehydrogenase (LDH) ratio, when levels of both enzymes were expressed as multiples of upper limit of normal value for each, w as significantly lower in Salmonella hepatitis. All Salmonella hepatit is cases had a ratio < 4, and all viral hepatitis cases had a ratio > 5, P < .0001. Left shift of white blood cells was more common in Salmo nella hepatitis (83% vs. 37%; P < .004). Patients with Salmonella hepa titis had a longer hospitalization (14.8 vs. 6.5 days, respectively; P < .0001). All 54 patients survived their illness. The clinical pictur e of Salmonella hepatitis is frequently indistinguishable from viral h epatitis. The admission ALT/LDH ratio is the best discriminator betwee n both entities. Other clues that raise the possibility of Salmonella hepatitis include high fever, relative bradycardia, and left shift of WBCs. Despite long hospitalization, Salmonella hepatitis responds to p roper antibiotic therapy and has an excellent prognosis.