Liver involvement during influenza infection: perspective on the 2009 influenza pandemic

Abstract

Please cite this paper as: Papic et al. (2011) Liver involvement during influenza infection: perspective on the 2009 influenza pandemic. Influenza and Other Respiratory Viruses 6(3), e2–e5.Elevation of liver transaminase levels is a frequent observation during systemic infections. The aim of our study was to investigate liver damage during pandemic 2009 influenza A/H1N1 infection in comparison with seasonal influenza. Serum levels of aspartate aminotransferase, alanine aminotransferase, and gamma‐glutamyl transpeptidase (GGT) were significantly higher in patients with pandemic influenza compared to seasonal influenza, which was strongly correlated with hypoxia. Moreover, a positive correlation between C‐reactive protein and serum GGT, alkaline phosphatase, and lactate dehydrogenase was noticed. Our findings support the hypothesis that the pandemic 2009 influenza A/H1N1 is an illness with a significant immune response to infection leading to hepatocellular injury.

The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection

“…This was supported in a small study of 11 patients infected with avian A(H7N9) virus infection who demonstrated a significant correlation between AST levels and the Th2 cytokines IL‐4 and IL‐9 . The absence of influenza virus antigen in hepatocytes and the correlation between elevated liver function tests and systemic markers of inflammation including CRP suggests that the underlying pathogenesis of influenza‐associated hepatic disease is likely a result of systemic inflammation …”

“…Hepatic complications of influenza are rarely reported, yet recent reports suggest that liver injury occurs in the setting of influenza infection . In an uncontrolled human challenge model of influenza infection, 4 of 15 human subjects experimentally inoculated with influenza developed elevated blood transaminase levels (greater than threefold the upper limit in two subjects) .…”

“…In an uncontrolled human challenge model of influenza infection, 4 of 15 human subjects experimentally inoculated with influenza developed elevated blood transaminase levels (greater than threefold the upper limit in two subjects) . Liver injury may be strain‐specific as a greater proportion of 97 patients with A(H1N1)pdm09 infection had elevated AST and ALT (25.78% and 26.31%, respectively) compared with 86 patients infected with 2008 seasonal influenza virus‐infected (18.6% and 7.36%, respectively) . Additionally, histopathologic evidence of centrizonal hemorrhagic necrosis was also reported in 78% of patients who died following A(H1N1)pdm09 virus infection .…”

Alteration of liver function due to H1N1 infection: a case report

“…Some authors believe that influenza A virus can affect any organ as a consequence of response to viral antigens 4. Involvement of other systems by the virus is considered rare.…”

“…Papic et al4 conducted a study in adults where liver function tests (AST, ALT, and GGT) were compared between H1N1 pandemic and seasonal groups. The study concluded that the liver function tests were higher in the pandemic group.…”