Jaundice in infectious diseases

Jaundice (Greek icterus) is a yellow discoloration of the skin and mucous membranes as a result of the accumulation of bilirubin in the blood serum and its subsequent deposition in tissues due to a disruption of the dynamic balance between the rate of its formation and excretion.

Normally (when determined using the Jendrasik method), the total bilirubin content (total bilirubin) in the blood serum is 3.4-20.5 μmol/l, indirect (unconjugated, or free) bilirubin - up to 16.5 μmol/l, direct (conjugated, or bound) - up to 5.1 μmol/l.

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Causes of Jaundice

Jaundice syndrome develops in many infectious diseases, primarily in icteric forms of acute viral hepatitis A, B, C and E, acute viral hepatitis of mixed etiology (mainly viral hepatitis B and viral hepatitis D, other combinations are extremely rare), as well as in superinfection with hepatitis viruses in patients with chronic hepatitis.

Causes of Jaundice

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Symptoms of Jaundice

Suprahepatic jaundice. The main symptom is an increase in the blood level of indirect bilirubin. This makes it easy to distinguish it from hepatic and subhepatic jaundice. Suprahepatic jaundice can be a consequence of:

• increased formation of bilirubin (hemolysis of red blood cells);
• disturbances in bilirubin transport (disruption of the process of binding to albumin);
• disturbances in the metabolism (conjugation) of bilirubin in hepatocytes.

Symptoms of Jaundice

Classification of jaundice

• By development mechanism:
  • suprahepatic (hemolytic);
  • hepatic (parenchymal);
  • subhepatic (mechanical or obstructive).
• By degree of severity:
  • mild (total bilirubin in blood serum up to 85 μmol/l);
  • moderate (total bilirubin 86-170 μmol/l);
  • pronounced (total bilirubin above 170 μmol/l).
• By duration of the course:
  • acute (up to 3 months);
  • protracted (from 3 to 6 months);
  • chronic (over 6 months).

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Diagnosis of jaundice

Jaundice is an isolated symptom that is considered only in conjunction with the patient's complaints, other examination and survey data. Jaundice is most easily detected by examining the sclera in natural light. It usually occurs when the bilirubin concentration in the blood serum is 40-60 μmol/l (exceeding normal values by 2-3 times). The level of bilirubinemia does not indicate the severity of the liver disease, but the degree of jaundice.

An important role is played by the epidemiological anamnesis, which allows one to assume the correct diagnosis already at the stage of questioning the patient. The patient's age, type of work and occupational hazards are determined. For a number of infectious diseases occurring with jaundice syndrome, trips to regions endemic for these diseases, to rural areas, contacts with wild and domestic animals, soil, swimming in water bodies, hunting or fishing, etc. are important. The presence, nature and sequence of appearance of concomitant clinical symptoms are necessarily determined.

Diagnosis of jaundice

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Treatment of jaundice

Jaundice itself, especially that caused by an increase in direct bilirubin, is not the object of therapeutic measures. On the contrary, indirect bilirubin, being a fat-soluble compound, can have a damaging effect on some structures of the nervous system with a high lipid content. It can manifest itself at a concentration of indirect bilirubin in the blood serum over 257-340 μmol/l. In premature infants, with hypoalbuminemia, acidosis, and the administration of a number of drugs that compete in the blood for binding to albumin (sulfonamides, salicylates), bilirubin has a damaging effect even at a lower concentration. Therapeutic measures aimed at reducing the intensity of jaundice are usually carried out only in newborns and young children with a high content of unconjugated bilirubin in the blood serum (Crigler-Najjar syndrome, etc.).

Treatment of jaundice