Which liver enzyme, SGOT (Serum Glutamic-Oxaloacetic Transaminase) or SGPT (Serum Glutamic-Pyruvic Transaminase), should be tested in Typhoid fever?

Liver Enzyme Testing in Typhoid Fever

Both SGOT (AST) and SGPT (ALT) should be tested in typhoid fever, as both are commonly elevated, with SGOT (AST) showing more frequent elevation (61.3% vs 48.4% for SGPT/ALT) in patients with typhoid fever.

Liver Involvement in Typhoid Fever

Typhoid fever commonly involves the liver, resulting in hepatic dysfunction that can be detected through liver enzyme testing. The evidence shows:

• Liver function abnormalities are present in up to 95% of typhoid fever patients 1
• SGOT (AST) is elevated in 61.3% of cases, while SGPT (ALT) is elevated in 48.4% of cases 2
• These elevations occur even in patients without clinical hepatomegaly 2

Clinical Presentation and Laboratory Profile

Typhoid fever often presents with:

• Fever (93% of patients) 1
• Headache (57% of patients) 1
• Gastrointestinal symptoms including diarrhea (33%), abdominal pain, nausea, and anorexia 1, 3
• Hepatomegaly in approximately 51.6% of cases 2
• Jaundice in 16.1% of cases 2

The laboratory profile typically shows:

• Normal or decreased leukocyte count
• Elevated liver enzymes (SGOT/SGPT)
• Increased erythrocyte sedimentation rate
• Thrombocytopenia in some cases 3

Monitoring Recommendations

When monitoring liver function in typhoid fever:

1. Initial testing: Both SGOT (AST) and SGPT (ALT) should be tested at diagnosis
2. Follow-up: Repeat testing 2-3 weeks after completion of antibiotic therapy 2
3. Expected course: Hepatic dysfunction is typically transient, with liver enzymes returning to normal within 2-3 weeks after successful antibiotic therapy 2

Diagnostic Considerations

• Typhoid hepatitis can mimic acute viral hepatitis, particularly in tropical regions 4
• In children presenting with fever and jaundice in endemic areas, typhoid hepatitis should be included in the differential diagnosis 4
• Blood cultures remain the gold standard for diagnosis of typhoid fever, but liver function tests can provide supportive evidence 5

Management Implications

• Abnormal liver function tests should not necessarily alter the standard treatment approach for typhoid fever
• Chloramphenicol remains effective for typhoid fever in many regions 3
• In patients with significant hepatic involvement, more careful monitoring of liver function may be warranted during treatment

Conclusion

While both SGOT and SGPT should be tested in typhoid fever, SGOT shows more frequent elevation. The hepatic dysfunction in typhoid fever is generally transient and resolves with appropriate antibiotic therapy. Monitoring both enzymes provides a more complete picture of liver involvement and can help distinguish typhoid hepatitis from other causes of liver dysfunction in febrile patients.