Can Liver Enzymes Be Elevated By A Bacterial Infection?

Bacterial infections, such as urinary tract infections or pneumonia, can release toxins or cause an immune response that affects the liver. In some cases, even an infection in another part of the body can trigger an immune response that indirectly affects the liver and raises liver enzyme levels. Elevated liver enzymes can be caused by pain medicines, alcohol, hepatitis, and other diseases. Viral infections, such as Hepatitis A, B, C, and E, Cytomegalovirus (CMV), and Epstein-Barr virus, are common culprits. There is a temporal association between the infection and liver enzyme abnormalities, but a direct link is yet to be made.

Some bacteria can also trigger liver inflammation, either directly or by causing abscesses or granulomas. Liver cirrhosis is an immunocompromised condition that increases the susceptibility to bacterial infection, resulting in liver dysfunction and damage. Evidence has shown an association of Helicobacter pylori infection with liver dysfunction and damage.

Liver diseases, medical conditions, medications, and infections can cause elevated liver enzymes. Your healthcare team will review your medicines and symptoms. Elevated liver enzymes may mean a person’s liver is not working properly, and common causes include fatty liver disease and cirrhosis. Systemic bacterial infections can have an indirect impact on many organ systems, including the liver. Elevated liver enzymes may indicate a person’s liver is not functioning properly.

Can bacterial infection affect liver enzymes?

Liver function test abnormalities and jaundice frequently accompany a variety of bacterial infections, especially sepsis.

Abstract. The liver is often involved in systemic infections, resulting in various types of abnormal liver function test results. In particular, hyperbilirubinemia in the range of 2-10 mg/dL is often seen in patients with sepsis, and several mechanisms for this phenomenon have been proposed. In this review, we summarize how the liver is involved in various systemic infections that are not considered to be primarily hepatotropic. In most patients with systemic infections, treatment for the invading microbes is enough to normalize the liver function tests. However, some patients may show severe liver injury or fulminant hepatic failure, requiring intensive treatment of the liver.

Keywords: Liver dysfunction, Liver function test, Systemic infection, Immunology, Liver failure.

Core tip: The liver is frequently involved in systemic infections, resulting in various types of abnormal liver function test results. It is very important to know the frequency and the patterns of abnormal liver function test results in each infection for the appropriate management of the patients. However, there have been few reports focusing on this issue. Here, we gather information from previous reports on this topic to provide a comprehensive summary that will help clinicians interpret abnormal liver function test results according to the associated infection.

Can high ALT be nothing?

It’s important to know that having a high ALT test result doesn’t necessarily mean you have a medical condition. Less than 5% of people with elevated ALT levels have severe liver conditions. Other factors can affect your ALT levels. Your provider will take into consideration several factors, including other blood test results and your medical history, when analyzing your results.

What does it mean if my alanine transaminase (ALT) is low?. Having a lower than normal ALT result is uncommon and usually isn’t a cause for concern. However, a lower than normal ALT level could indicate a vitamin B6 deficiency or chronic kidney disease.

If your ALT result is lower than what’s considered normal, your healthcare provider will likely have you retake the test or undergo further testing to make sure nothing is causing your low level.

Is liver damage from antibiotics reversible?

Sulfonamide-induced liver injury (DILI) occurs within the first month of administering a medication, with most forms being cholestatic. Macrodantin is well recognized to induce both acute and chronic liver disease, and may be indistinguishable from autoimmune hepatitis. Antifungals like ketoconazole and other azoles are associated with an increased risk of hepatotoxicity, with liver injury generally presenting as increased transaminase levels that are usually reversible. Patients on antifungal therapy require careful monitoring and administration should be abruptly stopped if liver enzymes become elevated. Oral terbinafine rarely induces DILI (1/45, 000 to 1/54, 000), but severe cases have been reported.

HIV antiretroviral therapy (HAART) can lead to DILI in up to 18 patients, with the risk increased by alcohol consumption, older age, and female gender. Successful treatment of HBV and HCV co-infection results in reduced hepatic toxicity of antiretroviral drugs. Drug combinations employed in HAART complicate the attempts to clearly identify the hepatotoxic potential of each individual medication. Clinical manifestations range from asymptomatic patients to acute liver failure and death.

Non-nucleoside analog reverse transcriptase inhibitors are the most likely culprits for hepatototoxicity, with hypersensitivity and idiosyncratic mechanisms implicated. Nevirapine is associated with a high incidence of liver toxicity, with a mixed pattern of liver injury. Abacavir-induced DILI is a risk factor for HLA-B*5701 positivity, so patients should be screened for this phenotype prior to treatment. Protease inhibitors induce DILI in 6-11 of patients, but the incidence is significantly increased in HBV or HCV co-infections and alcohol consumption.

Can an infection raise ALT levels?

DISCUSSION. Nonspecific reactive hepatitis is defined as a secondary hepatic injury induced by a non-hepatic disease, without parenchymal liver damage. It is common for patients with a respiratory virus infection to lack clinical presentations while showing increased ALT or AST levels, which then drop to normal levels, with a good prognosis upon improvement of the infection. The exact mechanism is unknown, but Polakos et al. reported that collateral damage seems to induce the condition, considering that apoptotic hepatocytes, antigen-specific CD8+ T cells, and Kupffer cells appear around the inflamed area, while the virus is not present in hepatocytes.

Other studies on nonspecific reactive hepatitis have reported that it occurs more frequently in younger age groups . In the present study, there was no significant difference between the age of patients with increased levels of either ALT or AST and that of patients with normal levels for both. However, when patients in the increased ALT and AST groups were separately analyzed, the mean age of patients in the increased ALT level group (16. 0±35. 8 months) was significantly lower than that of patients in the normal group (25. 8±26. 6 months). On the contrary, there was no significant age difference between patients in the increased AST level group and those in the normal group. This indicates that younger patients with respiratory virus infection are more vulnerable to nonspecific reactive hepatitis, and the degree of influence on hepatic function is better reflected via ALT than AST levels.

Studies have suggested higher incidences of nonspecific reactive hepatitis in men than in women, but no sex-specific differences were found in the present study .

Can your liver recover from high liver enzymes?

About one-third of people with elevated liver enzymes will have normal liver enzyme levels after two to four weeks. If your liver enzymes stay high, your provider may order more blood tests, or imaging tests such as ultrasound, CT scan or MRI. They may also refer you to a liver specialist (hepatologist).

What does it mean to have elevated liver enzymes?. If you have high levels of liver enzymes in your blood, you have elevated liver enzymes. High liver enzyme levels may be temporary, or they may be a sign of a medical condition like hepatitis or liver disease. Certain medications can also cause elevated liver enzymes.

What are liver enzymes?. Liver enzymes are proteins that speed up chemical reactions in your body. These chemical reactions include producing bile and substances that help your blood clot, breaking down food and toxins, and fighting infection. Common liver enzymes include:

• Alkaline phosphatase (ALP).
• Alanine transaminase (ALT).
• Aspartate transaminase (AST).
• Gamma-glutamyl transferase (GGT).

What virus causes elevated liver enzymes?

• Non-alcoholic fatty liver disease (NAFLD). This is probably the main reason for elevated liver enzymes in children in the U. S. today. Mild forms of this disease are very common
• the more serious form that over many years can lead to cirrhosis (scarring) and liver failure is called non-alcoholic steatohepatitis (NASH).
• Certain medicines. Drug-induced liver injury (DILI) is another possibility. Medications that can affect the liver include those for attention-deficit/hyperactivity disorder, such as atomoxetine
• antibiotics, such as erythromycin or minocycline
• anticonvulsants, such as valproic acid
• or products containing acetaminophen. Drug-induced liver injury is often mild, but sometimes it can be severe.
• Viral infections. Many viruses can temporarily increase liver enzyme levels. These include rhinovirus (common cold) or Epstein-Barr virus (EBV), the virus that causes mononucleosis (“Mono”).

Rarely are elevated liver enzymes due to a serious or even life-threatening condition. Some of these less common causes include:

• Autoimmune hepatitis (AIH)
• Hepatitis B and C
• Diseases of the bile ducts, such as biliary atresia, choledochal cyst, or bile duct blockage from a gallstone or from pancreatitis
• Diseases of other organs, such as celiac disease, a disorder of the intestine (gut)
• Genetic (inherited) conditions, such as alpha-1 antitrypsin (AAT) deficiency (where a protein gets produced incorrectly and “gets stuck” in the liver), hemochromatosis (too much iron) or Wilson disease (too much copper)

Can a viral infection affect liver enzymes?

During the viremic phase characterized by fever and chills, the virus may spread to other tissues and organs including the liver. Observations in routine clinical practice indicate that pediatric patients with ARTI exhibit elevated serum liver enzyme activities (ELEA) as an indicator of hepatic involvement.

Can inflammation cause elevated liver enzymes?

Elevated liver enzymes often are a sign of inflamed or damaged cells in the liver. Inflamed or injured liver cells leak higher levels of certain chemicals into the bloodstream. These chemicals include liver enzymes that may appear higher than usual on blood tests.

What is an alarming liver enzyme?

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are two liver enzymes measured in a blood test to check the health of your liver. High AST and ALT levels are a general sign of a liver problem.

Based on which enzyme is elevated—or if both are elevated—healthcare providers can make an educated guess as to the underlying cause of the liver problem and order additional tests. This may help diagnose diseases ranging from hepatitis and cirrhosis to liver cancer and liver failure.

When ALT and AST Levels Are Tested. ALT and AST are part of a comprehensive panel of tests known as a liver function test (LFT). An LFT may be ordered:

• If you have symptoms of liver disease, including jaundice (yellowing of the skin or eyes), dark urine, pale stools, nausea, vomiting, and fatigue
• To monitor the progression of a liver disease
• To determine when drug treatments should be started
• To check your response to treatment

What is the most common cause of high liver enzymes?

There are many causes of mildly elevated ALT and AST levels. The most common causes are nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease. In NAFLD, the liver has more fatty tissue in it than normal. Regular or heavy alcohol use can also hurt the liver and increase liver enzymes. Other medical conditions can increase liver enzymes, like hepatitis B or C and a condition that runs in families called hemochromatosis. Using certain medicines and over-the-counter supplements can also increase liver enzymes.

People with mild elevations in liver enzymes usually do not have symptoms.

Your doctor will ask you questions and examine you to try and find out why your liver enzymes are elevated. He or she may also do blood tests. A scan of your liver, called an ultrasound, might help your doctor find a cause.

Can liver enzymes be elevated due to antibiotics?

The study examines the impact of antibiotics on liver enzyme elevation in patients with diastolic liver failure (DILI). The maximum levels of AST and ALT were 181. 5U/L and 201. 0 U/L, respectively. After medication stop, all DILI patients naturally recovered without any cases of liver transplantation or death. The most common antibiotics that elevated liver enzyme levels were flomoxef, cetrazole, ceftriaxone, vancomycin, piperacillin/tazobactam, and amoxicillin/clavulanate. Flomoxef was the most common antibiotic that caused DILI, with eight patients out of 24 patients showing elevated liver enzymes more than three times. In outpatients, flomoxef was the most common antibiotic prescribed for outpatients, followed by ceftriaxone, ciprofloxacin, sulfamethoxazole/tripethoprim, isoniazid, and amoxicillin/clavulanate. The prevalence of abnormal liver enzyme was highest in the flomoxef group, with 32 patients showing elevated levels exceeding the upper normal limit. Ciprofloxacin, isoniazid, ceftriaxone, sulfamethoxazole/trimethoprim, and amoxicillin/clavulanate were the most common antibiotics prescribed for outpatients. The study found that the frequency and degree of liver enzyme elevation by antibiotics varied, with flomoxef being the most common.