Clinical spectrum and outcome of elevated serum transaminases in tropical infections among children aged one month to 18 years in an urban tertiary care centre: a prospective observational study


  • Abhinaya Venkatesan Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, India
  • Sumathi Bavanandam Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, India
  • Thangavelu Sangaralingam Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, India
  • Nedunchelian Krishnamoorthy Department of Pediatrics, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, India



Tropical infections, Transaminitis, Hepatosplenomegaly


Background: Tropical infections are common in our country and occur with a variable elevation of transaminases in a majority of them and they pose as a differential diagnosis to the viral infections affecting the liver including COVID-19 and complications like HLH and also paracetamol toxicity. Aim was to study the clinical profile and degree of elevation of liver enzymes in tropical infections in children aged one month to18 years.

Methods: A prospective observational study of children from one month to 18 years of age with tropical infections in Mehta's multispeciality hospitals, Chennai, India between June 2017 and May 2019 was analyzed. Elevation of liver enzymes was categorized as mild (1-3 fold), moderate (3-20 fold) and severe (>20 fold).

Results: Dengue was the most common infection in our study and the majority (49.07%), followed by enteric fever (78.06%), malaria (27.27%) and leptospirosis (25%), all had a mild elevation of SGOT. Severe elevation of SGOT was seen in 25% of leptospirosis and less than 10% in malaria and none with scrub typhus. SGPT elevation was severe in 50% of leptospirosis. Dengue shock syndrome had a severe elevation of transaminases.

Conclusions: The most common infection was dengue and the majority had mild elevation and those with shock had a severe elevation of transaminases whereas shock was not a feature in leptospirosis even in severe elevation in our study. Though liver enzymes were very much elevated, children recovered without any residual liver damage.



WHO. Fact sheet: Dengue guidelines for diagnosis, treatment, prevention and control: new edition, 2009. Available at: Accessed on 17 January 2022.

Onyesom I, Onyemakonor N. Levels of parasitaemia and changes in some liver enzymes among malarial infected patients in Edo-Delta Region of Nigeria. Curr Res J Biol Sci. 2011;3(2):78-81.

Thapa BR, Walia A. Liver function tests and their interpretation. Indian J Pediatr. 2007;74(7):663-71.

Bhutta ZA. Salmonella: infectious diseases. Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier Inc; 2016: 3467.

Talwani R, Gilliam BL, Howell C. Infectious disease and the liver. Clin Liver Dis. 2011;15(1):111-30.

Tambolkar SA, Mishra A, Joshi H, Agarkhedkar S. Liver functions as a marker of severity of disease in children with dengue fever. Web Med Central Paediatr. 2015;6(8):004962.

Prommalikit O, Thisyakorn U, Thisyakorn C. Serum aminotransferases in thai children with dengue infection. Iran J Pediatr. 2015;25(6):443.

Laoprasopwattana K, Jundee P, Pruekprasert P, Geater A. Outcome of severe dengue viral infection-caused acute liver failure in Thai children. J Tropic Pediatr. 2016;62(3):200-5.

Dheer G, Kundra S, Singh T. Clinical and laboratory profile of enteric fever in children in northern India. Tropic Doctor. 2012;42(3):154-6.

Mehta SR, Naidu G, Chandar V, Singh IP, Johri S, Ahuja RC. Falciparum malaria-present day problems. An experience with 425 cases. J Indian Med Assoc. 1989;37(4):264-7.

Singh K. Evaluation and interpretation of biomarkers of liver diseases. Int J Res Health Sci. 2013;1(3):213-3.

Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India. 2010;58(1):24-8.

Kispotta R, Kasinathan A, Kumar Kommu PP, Manikandan M. Analysis of 262 children with scrub typhus infection: a single-center experience. Am J Tropic Med Hyg. 2020:201019.






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