Hepatic involvement as just one component of a more generalized systemic infection occurs with some viruses (cytomegalovirus, Epstein-Barr virus), protozoa (Coxiella), parasites (malaria), and fungi (hepatosplenic candidiasis), particularly in immunosuppressed patients. Typhoid fever may cause an unusual hepatitis, but the jaundice in leptospirosis is due to hemolysis rather than hepatocellular injury.
Gram-negative sepsis in infants is often associated with hyperbilirubinemia, and may be due to lipopolysaccharide interference with bile-salt-independent bile flow. Bile salt pool and synthetic rates are low in infants, and impairment of bile-salt-independent flow may be more likely to result in a cholestatic syndrome. A large prospective study of 84 adult cases of bacteremia, 34 per cent of which were due to Gram-positive organisms, found liver blood test abnormalities in 65 per cent irrespective of the organism, the age or sex of the patient, the origin of the sepsis, or mean arterial pressure. Biochemical findings were of no prognostic significance, but in a series of cases with staphylococcal endocarditis mortality was five times higher in those presenting with jaundice. Abnormalities of liver function are also very common in the toxic shock syndrome. Jaundice due to a wide range of organisms, including Mycobacterium avium intracellulare complex and Cryptosporidium, may also develop in those with HIV infection.
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