Why does mononucleosis cause liver ASL and AST levels to be 4 to 5 times higher than the normal range?

Question

My daughter was diagnosed with mononucleosis. Her liver function levels now are AST 200 and ALT 300. Why does mono attack the liver and what should we be doing, medically, to help fight this?

Answer 1

One of the many functions of the liver is to make factors to help the human immune system fight infection. The most impt first step to diagnose the viral infection of Mononucleosis is to do liver function tests to determine elevated liver enzymes of ASL N:SI [# Argininosuccinate Lyase] and AST N:SI [# Aspartate Aminotransferase].

Liver function Tests
A typical Liver Function Test measures several levels of enzymes and other factors. Several laboratory assays are commonly called liver function tests (LFTs), although these tests are neither specific to the liver nor true measures of liver function. As a result, alanine aminotransferase (ALT or SGPT), aspartate aminotransferase (AST or SGOT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and bilirubin have proven problematic for clinicians. These include:

• AP (Alkaline Phosphatase) U/L (30 to 120)
• GGT (Gamma-glutamyl transpeptidase) U/L (5 to 35)
• LD Lactate Dehydrogenase U/L (100-225)
• AST (Aspartate aminotransferase) U/L (5 to 45)
• ALT (Alanine aminotransferase) U/L (5 to 45)
• Albumin g/L (38-55)
• Clotting Studies (Prothrombin Time) Seconds (11 to 13.5)
• Total Bilirubin - Normal range is 3 - 18 umol/L (0.174 - 1.04mg/dL).

Lactate Dehydrogenase, a liver enzyme found in many body tissues, especially the heart, liver, kidney, skeletal muscle, brain, blood cells, and lungs. LDH catalyzes the interconversion of pyruvate and lactate. Exercising muscles convert (and red blood cells metabolize) glucose to lactate.




Mononucleosis ( kissing disease) is a viral infection causing fevers, sore throat, and swollen lymph glands, especially in the neck. It is usually linked to the Epstein-Barr virus (EBV), but can also be caused by other organisms such as cytomegalovirus (CMV).


During a physical examination, the doctor may find swollen lymph nodes in the front and back of the neck, as well as swollen tonsils with the whitish covering. The doctor might also find a swollen liver or swollen spleen when pushing on your belly. There may be a skin rash.

Laboratory findings often include a higher-than-normal white blood cell count, and the characteristic finding of atypical lymphocytes -- unusual-appearing white blood cells that are seen when blood is examined under a microscope. Abnormal liver function tests are also characteristic.


Treatment

Most patients recover within 2-4 weeks without medication. Younger children often don't have symptoms, while some older patients may have fatigue for up to 6 weeks.

There is no specific treatment available. Antiviral medications do not help. Steroid medication may be considered for patients with severe symptoms.

To relieve typical symptoms:

Take acetaminophen or ibuprofen for pain and fever.
Gargle with warm salt water for sore throat.
Get plenty of rest. Drink plenty of fluids.
Avoid contact sports while the spleen is swollen (to prevent it from rupturing).


Expectations (prognosis)

The fever usually drops in 10 days, and swollen lymph glands and spleen heal in 4 weeks. Fatigue usually goes away within a few weeks, but may linger for 2 to 3 months


Prevention

The infection is probably spread by saliva and close contact. People may be contagious while they have symptoms and for up to a few months afterwards. The virus can live for several hours outside the body. Avoid kissing or sharing utensils if you or someone close to you has mono. The exact period that people are contagious varies

Answer 2

ASL and ALT (not sure what AST is) are enzymes found in the liver, and when the liver is irritated/damaged/diseased (inflammation of the liver is a possible side effect of mononucleosis) more of these enzymes are released into the bloodstream.

As far as specifically fighting the enzyme levels; I don't think there is anything specific that can be done. The levels will resolve back to normal as the mononucleosis is treated.

There is a lot of information on mono; not sure if you've read up on it in terms of how to effectively (and how not) to have it treated. Just some things you may want to discuss with your doctor (especially if your daughter is young).

Wikipedia
http://en.wikipedia.org/wiki/Infectious_mononucleosis

Medicine Net
http://www.medicinenet.com/infectious_mononucleosis/article.htm

WebMD
http://www.webmd.com/a-to-z-guides/understanding-mononucleosis-basics

WebMD has a lot of other corresponding articles as well including treatment, symptoms, testing etc.

Answer 3

You know. That happened to someone I know. Someone I am very close to and am part of their ongoing treatment. The doctor kept saying that it could be due to medication (meds was for other reasons not liver related) and that it's nothing to be concerned about. About 4 years later, nausea, and SEVERE bloating. Ultrasound showed cihorrosis. Not a drinker or drug user. The person's liver is failing and is now on a transplant list. Gastroenterologist said the liver is very forgiving, but once symptoms like this show up, it has had enough. This cirrohsis was cause by the bodies own immune system, but I wish the first doctor would have had the insight to order an ultrasound years back. But even if you get an ultrasound, sometimes the cirrohsis cannot be detect because ultrasounds are not exact. Trust me, been there, heard that. Insist on tests to actually test your liver's size and shape. Maybe several ultrasounds. I don't want to scare you, but you owe it to yourself to step out of the box the doctors have drawn and insist on more. God bless.

Answer 4

Ast Levels

Answer 5

1

Answer 6

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Please see the web pages for more details on AST (Serum glutamic-oxaloacetic transaminase- SGOT) and ALT (SGPT- Serum glutamate pyruvate transaminase).