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Background: Liver damage is commonly seen in dengue infection, which can sometimes lead to acute liver failure. Although the
exact causes of liver injury is unknown, direct viral injury, hypoxic
injury due to vascular leakage and immune mediated liver damage
are thought to contribute to liver involvement in dengue. Therefore, w e proceeded to investigate the patterns of liver injury and
the possible contributing factors in acute dengue infection.
M ethods & M aterials: 55 adult patients w ith confirmed acute
dengue infection were recruited during day 3 -5 of the illness and
serial recordings of liver function tests, viral loads, serum IL10 and
IL17 levels and the extent of fluid leakage were measureddaily until
discharge from hospital. According to the 2011 WHO guidelines,
19 of these patients w ere classified as dengue haemorrhagic fever
(DHF) and 36 w ere classified as dengue fever (DF).
Results: Serum alanine transaminase (ALT), aspartate transam
inase (AST), conjugated and unconjugated bilirubin, gamma
glutamyl transaminase and alkaline phosphatase levels w ere highest on day 7 of illness in patients w ith DHF and DF. Serum albumin
levels w ere only lower in patients w ith DHF. The peak in liver
enzymes occurred 2 days after the peak of viraemia in patients w ith
DHF and DF. The extent of the rise in liver enzymes did not correlate w ith the extent of vascular leak and there were no significant
differences in any of the liver enzymes between patients w ith DF
or DHF. In contrast, IL-17 levels were significantly associated with
ALT levels (p=0.02, Spearmans r= 0.17). IL-17 levels w ere significantly higher (p=0.008) on day 5 of illness in patients w ith ALT
levels >4 times the upper limit of normal (m ean 38.2 SE±10.1),
w hen compared to those w ith lesser degree of liver involvement
(10.3,SE±10.2). Although IL-10 w ere higher in patients w ith higher
AST levels, this was not significant
Conclusion: Dengue associated liver injury appears to peak at
day 7 of illness and appears to associate w ith serum IL-17 levels
but not w ith the degree of fluid leakage or viraemia. Since IL17
was also shown to cause liver injury in dengue mice models, the
mechanisms by which this occurs needs to be further investigated
