Ischemic Hepatitis and Collateral Damage to the Liver in Severe Viral Respiratory Tract Infections
Abstract
University of Liverpool, Liverpool, United Kingdom <h2>To the Editor-in-Chief:</h2> Polakos and colleagues 1 investigated immunological causes of hepatic involvement by influenza virus respiratory tract infection manifesting itself in alanine and aspartate aminotransferase elevation and found evidence for a role of antigen-specific T cells in their pathogenesis. Transaminase levels are not routinely determined in ward or ambulatory patients with influenza virus infection because transaminase level elevation is not associated with clinically significant hyperbilirubinemia and jaundice. Transaminase levels are, however, frequently determined in patients in the intensive care unit. Adams and Hubscher 2 mention in their commentary on the work of Polakos and colleagues 1 our observational study, 3 in which we reported on the finding of elevated transaminase levels in 46% of children ventilated in the pediatric intensive care unit with severe respiratory syncytial virus bronchiolitis. In our study we found evidence for a cause of collateral hepatic damage in respiratory syncytial virus infection, which is not related to immunological processes. Eighty-six percent of patients with, but only 27% of patients without, congenital heart disease had elevated transaminase levels ( P < 0.001). In patients with congenital heart disease, we also found elevated cardiac troponin T levels, probably indicating