From the Guidelines
Yes, tick-borne illnesses can cause elevated liver function tests (LFTs). Infections such as Lyme disease, Rocky Mountain spotted fever, ehrlichiosis, anaplasmosis, and babesiosis can all affect the liver, leading to abnormal LFT results, as noted in the guidelines for the diagnosis and management of tickborne rickettsial diseases 1. These elevations typically manifest as increased levels of transaminases (ALT and AST), alkaline phosphatase, and occasionally bilirubin. The liver involvement occurs because these pathogens can trigger systemic inflammatory responses, directly infect liver cells, or cause immune-mediated damage to hepatic tissue.
Key Points to Consider
- The elevation in LFTs is usually mild to moderate and resolves with appropriate antimicrobial treatment of the underlying tick-borne infection.
- Common treatments include doxycycline (100mg twice daily for 10-21 days) for most tick-borne diseases, or specific regimens based on the identified pathogen, as recommended by the Infectious Diseases Society of America 1 and the MMWR Recommendations and Reports 1.
- If you suspect a tick-borne illness with liver involvement, it's crucial to seek prompt medical evaluation, as early treatment leads to better outcomes and prevents complications, with doxycycline being the drug of choice for treatment of all tickborne rickettsial diseases in patients of all ages 1.
- Regular monitoring of LFTs during treatment can help track liver recovery, and treatment decisions for rickettsial pathogens should never be delayed while awaiting laboratory confirmation, as delay in treatment can lead to severe disease and long-term sequelae or death 1.
From the Research
Elevated LFTs from Tick-Borne Illness
- Elevated Liver Function Tests (LFTs) can be associated with tick-borne illnesses, as seen in Lyme disease 2, 3, 4.
- A study published in 1993 found that 27% of patients with early Lyme disease had liver function abnormalities, with elevation of gamma-glutamyltransferase being the most common finding 2.
- Another study from 2020 highlighted that GI and hepatic symptoms, including liver test elevation, are quite common in Lyme disease patients and should be considered in the differential diagnosis of patients from endemic regions 3.
- Moderate elevations of liver enzymes may occur in tick-borne infections, including Lyme disease, human granulocytic ehrlichiosis, and babesiosis 4.
- Ehrlichiosis should also be considered in the differential diagnosis of acute febrile illness with GI symptoms, especially in the presence of leukopenia/thrombocytopenia and/or liver test elevation 3.
Specific Tick-Borne Illnesses
- Lyme disease is the most commonly reported tick-borne illness in the United States, with over 90% of cases occurring in northeastern states 5.
- Other tick-borne illnesses, such as ehrlichiosis, Rocky Mountain spotted fever, and babesiosis, can also present with GI and hepatic symptoms, including liver test elevation 3, 6, 4.
- Co-infections with these agents can exist, and diagnosis should be documented by detection of the organisms rather than by serology 4.