Acute Hepatocellular Injury Associated With Azithromycin

C, Ellison; Blackwell, Sarah B.

doi:10.1177/0897190019894428

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…Liver toxicity might involve the drug-cytochrome P-450 interaction, as reported for azithromycin [109,110], lopinavir/ritonavir [62,111], hydroxy-chloquine [112,113], and acetaminophen [114,115].…”

Section: The Liver Damage Caused By Agents Used For Treatment Of the Infectionmentioning

confidence: 95%

Hepatic consequences of COVID-19 infection. Lapping or biting?

Portincasa

Krawczyk

Machill

et al. 2020

European Journal of Internal Medicine

109

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The outbreak of coronavirus disease 2019 (COVID-19) starting last December in China placed emphasis on liver involvement during infection. This review discusses the underlying mechanisms linking COVID-19 to liver dysfunction, according to recent available information, while waiting further studies. The manifestations of liver damage are usually mild (moderately elevated serum aspartate aminotransferase activities), and generally asymptomatic. Few patients can still develop severe liver problems, and therapeutic options can be limited. Liver dysfunction may affect about one-third of the patients, with prevalence greater in men than women, and in elderly. Mechanisms of damage are complex and include direct cholangiocyte damage and other coexisting conditions such as the use of antiviral drugs, systemic inflammatory response, respiratory distress syndromeinduced hypoxia, sepsis, and multiple organ dysfunction. During new COVID-19 infections, liver injury may be observed. If liver involvement appears during COVID-19 infection, however, attention is required. This is particularly true if patients are older or have a pre-existing history of liver diseases. During COVID-19 infection, the onset of liver damage impairs the prognosis, and hospital stay is longer. SymptomsDuring COVID-19 infection, patients can be asymptomatic or present clinical symptoms ranging from fever, dry cough, headache to dyspnea and fatigue, to acute respiratory distress syndrome (ARDS), shock, and cardiac failure [9,16]. A nasopharyngeal swab is the collection method used to obtain a specimen for testing. Because the likelihood of the SARS-CoV-2 being present in the nasopharynx increases over time, repeated testing is often used [17]. Multi-organ

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Section: The Liver Damage Caused By Agents Used For Treatment Of the Infectionmentioning

confidence: 95%

Hepatic consequences of COVID-19 infection. Lapping or biting?

Portincasa

Krawczyk

Machill

et al. 2020

European Journal of Internal Medicine

109

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“…More recently, azithromycin in association with HCQ has become a therapeutic option for COVID-19 patients[ 44 , 45 ]. Biliary and hepatocellular injury have been associated with azithromycin use[ 34 - 36 ]. Another report with 18 patients presenting with azithromycin-induced DILI described a wide range of histopathological abnormalities, including hepatitis, veno-occlusive changes and/or central venulitis acute cholestasis and cholestatic hepatitis[ 35 ].…”

Section: Other Causes Of Liver Injury In Sars-cov-2mentioning

confidence: 99%

Mechanisms and consequences of COVID-19 associated liver injury: What can we affirm?

Brito¹,

Barros²,

Lopes³

2020

WJH

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Since the first reports of coronavirus disease 2019 (COVID-19) cases in December 2019 in China, numerous papers have been published describing a high frequency of liver injury associated with severe acute respiratory syndrome coronavirus 2 infection, many of them proposing a link between these findings and patient outcomes. Increases in serum aminotransferase levels (ranging from 16% to 62%) and bilirubin levels (ranging from 5% to 21%) have been reported and seem to be more often observed in patients with severe forms of COVID-19. Although absolute changes in these parameters are frequently seen, other variables, such as the ratio above the upper limit of normal, the onset of liver injury as a complication in severe cases and histopathological findings, reinforce that liver changes are of dubious clinical relevance in the course of this disease. Other factors must also be considered in these analyses, such as the repercussions of hemodynamic changes, the presence of thrombotic events, and, mainly, the possible drug-induced liver injury with the current, yet off-label, treatment. This paper aimed to analyze the currently available data on liver injury in patients with COVID-19.

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“…Certain drugs are alleged to play a role in GI and liver injury. The possible mechanisms include reactive metabolites and oxidative stress, idiosyncratic through drug-cytochrome P-450 interaction, or synergistic inflammatory response [ 61 – 63 ]. Table 1 summarizes the potential therapeutic agents, their mechanism of action, common side effects relating to the GI and liver, and possible drug-drug interactions (DDIs).…”

Section: Main Textmentioning

confidence: 99%

SARS-CoV-2-associated gastrointestinal and liver diseases: what is known and what is needed to explore

Sweed

Abdelsameea

Khalifa

et al. 2021

Egypt Liver Journal

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Background The pandemic of COVID19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in China as an unexplained pneumonia transmitted by respiratory droplets. Gastrointestinal (GI) and liver injury associated with SARS-CoV-2 infection were reported as an early or sole disease manifestation, mainly outside China. The exact mechanism and incidence of GI and liver involvement are not well elucidated. Main body We conducted a PubMed search for all articles written in the English language about SARS-CoV-2 affecting the GI and liver. Following data extraction, 590 articles were selected. In addition to respiratory droplets, SARS-CoV-2 may reach the GI system through the fecal-oral route, saliva, and swallowing of nasopharyngeal fluids, while breastmilk and blood transmission were not implicated. Moreover, GI infection may act as a septic focus for viral persistence and transmission to the liver, appendix, and brain. In addition to the direct viral cytopathic effect, the mechanism of injury is multifactorial and is related to genetic and demographic variations. The most frequently reported GI symptoms are diarrhea, nausea, vomiting, abdominal pain, and bleeding. However, liver infection is generally discovered during laboratory testing or a post-mortem. Radiological imaging is the gold standard in diagnosing COVID-19 patients and contributes to understanding the mechanism of extra-thoracic involvement. Medications should be prescribed with caution, especially in chronic GI and liver patients. Conclusion GI manifestations are common in COVID-19 patients. Special care should be paid for high-risk patients, older males, and those with background liver disease.

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Acute Hepatocellular Injury Associated With Azithromycin

Cited by 14 publications

References 14 publications

Hepatic consequences of COVID-19 infection. Lapping or biting?

Hepatic consequences of COVID-19 infection. Lapping or biting?

Mechanisms and consequences of COVID-19 associated liver injury: What can we affirm?

SARS-CoV-2-associated gastrointestinal and liver diseases: what is known and what is needed to explore

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