Correlation between cholestasis and infection

Abstract

This is an overview of cytokine-induced cholestasis, justified by the insufficient knowledge of this frequent type of cholestasis. In the presence of an infectious agent a systemic and intrahepatic production of proinflammatory cytokines results (TNF-alpha, IL-1beta, IL-6 etc.), stimulated by microbial lipopolysaccharides. In patients having systemic infections, the liver has several major functions: source of the inflammatory cytokines produced as a response to infection and a target of these inflammation mediators. The inflammatory cytokines interfere with the activity of both the sinusoidal and canalicular transporting systems. One of the potential consequences of this process is the appearance of cholestasis. An infection can lead to cholestasis despite the absence of direct invasion of the liver by the infectious agent. Particularly the cholestasis produced when the infection generating agent is not located in the liver (sepsis or extrahepatic infections) has been emphasized. The clinical aspect of the diseases associated with this type of cholestasis and the effects of anti-infectious therapy on cholestasis are presented. Cytokine-induced cholestasis represents a common pathogenic path for several diseases: hepatitides that present with an intrahepatic cholestatic pattern (viral, ethanol-induced, NSAID-induced), but also many other infections, which are sometimes overlooked because of the lack of clinical signs. When a preexistent liver disease is present, the cholestasis incidence is higher. In this latter condition, ignorance of this possible mechanism of cholestasis will lead to misdiagnosis and unnecessary tests, sometimes expensive and useless.