A problem that occurs during or after a trip does not necessarily need to have a causal connection with that trip.
- Pseudo-icterus (hypercarotenaemia, mepacrine therapy) should be differentiated from true icterus (jaundice). Check the colour of sclerae and the case history. Eating an excessive amount of carrots or papaya is a frequent cause of deep yellow-orange skin, but with normal sclerae.
- Patients with Gilbert syndrome could be icteric as a result of intercurrent infections. An increase in unconjugated bilirubin is found.
- A prehepatic, hepatic or post-hepatic cause is often differentiated in icterus. Mixed causes frequently occur. Icterus occurs with liver amoebiasis and schistosomiasis only very late, in the pre-terminal stage.
- Malaria
- Bartonellose (acute stage)
- Babesiosis
- Haemoglobinopathy e.g. sickle cell anaemia, thalassemia major / intermedia
- G6PD-deficiency with triggering factor (favism)
- Venom of certain snakes or spiders (Loxosceles sp)
- Paroxysmal cold haemoglobinuria (among others with tertiary syphilis)
- Hypersplenism (generally causes subicterus)
- Yellow fever
- Viral hepatitis A, B, C, D, E
- Medicinal and alcoholic hepatitis
- Leptospirosis
- East African trypanosomiasis
- Recurrent fever (borreliosis)
- Q fever (Coxiella burnetii) is a rare cause of jaundice
- Typhoid fever can in rare cases cause jaundice
- Liver decompensation due to acute liver failure after consumption of toxic mushrooms, such as Gyromitra sp., Amanita phalloides
- Budd-Chiari syndrome (occlusion of vena hepatica)
- Veno-occlusive disease resulting from ingestion of vegetable pyrrolizidine alkaloids (Heliotropium, Crotalaria, Senecio sp). See also Jamaican bush tea.
- Cosmopolitan diseases, e.g. auto-immune hepatitis, biliary cirrhosis
- Bile duct obstruction by liver flukes (Fasciola, Clonorchis), ectopic migrating Ascaris, gallstone, carcinoma. Cholangiocarcinoma is a late complicaton of chronic Clonorchis sinensis infection.
- Mirizzi syndrome (stone in the ductus cysticus with compression of the ductus hepaticus)
- Carcinoma of the head of the pancreas: deep epigastric pain with a greatly enlarged gallbladder is suggestive.
