title: Hepatic dysfunction in pediatric scrub typhus: role of liver function test in diagnosis and marker of disease severity.
abstract: OBJECTIVE
  Determine the frequency of abnormalities of liver function test in children with scrub typhus and its relation with severity of disease.
  
  
  METHODS
  Fifty-four children diagnosed with scrub typhus at Chiang Rai Regional Hospitalfrom 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 > or = 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. Hypoalbuminemia and hyperbilirubinemia were detected in 23 (42.6%) and 4 (7.4%) cases, respectively. The higher level of AST, ALT and lower level ofserum albumin correlated significantly with the severity of scrub typhus in children.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pediatric Unit, Chiang Rai Regional Hospital, Chiang Rai, Thailand.
authors.forename: Chulapong
authors.initials: C
authors.lastname: Chanta
authors.forename: Krilerk
authors.initials: K
authors.lastname: Triratanapa
authors.forename: Preecha
authors.initials: P
authors.lastname: Ratanasirichup
authors.forename: Warangkana
authors.initials: W
authors.lastname: Mahaprom
mesh_terms: D000410:Alanine Transaminase; D001219:Aspartate Aminotransferases; D015415:Biomarkers; D002648:Child; D002669:Child Welfare; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D011446:Prospective Studies; D012612:Scrub Typhus / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase