Viruses Affecting the Pancreas

Introduction

During the viremic phase of many systemic infections, pancreatic infection is likely to be common. However, as most viral infections are not fatal and because pancreatic changes may be subtle and therefore not adequately investigated, less attention has been directed towards the viral effects of pancreatitis than is the case for many other organs.

Nevertheless, studies on children with disseminated fatal viral infections showed that pancreatic lesions, often with islet cell destruction, were present in patients with coxsackie B, CMV, varicella-zoster and congenitally acquired rubella. In addition, pancreatitis has been observed following mumps and, less commonly, following Epstein-Barr virus (EBV) infection and hepatitis B virus infections. The finding that hepatitis B surface and core antigens have been detected in the acinar cells of patients with hepatitis B antigenemia suggests that this virus may replicate in pancreatic tissue. Although such filoviruses as Marburg and Ebola induce generalized infections with severe hepatic involvement, some patients develop clinical features of acute pancreatitis, and postmortem studies have demonstrated areas of focal pancreatic necrosis.

EBV infections are closely involved in the pathogenesis of Burkitt's lymphoma and this lymphoma may be found at autopsy to involve the pancreas relatively commonly. It may present clinically as a diffuse enlargement of the pancreas, this being due to the tumor itself, or a pancreatitis resulting from tumor lysis induced by chemotherapy.

Mumps

The exact frequency of pancreatitis complicating mumps is not known although a figure of about 5% has been suggested. Experimental studies employing human cell cultures have shown that mumps virus may destroy islet cells.

Patients present with epigastric pain, often severe, and vomiting, during which time serum amylase levels are markedly raised. In general, patients make a good recovery although rarely a severe hemorrhagic pancreatitis may occur.

Enteroviruses

Some studies have suggested that enteroviruses, particularly coxsackie B viruses, may cause acute pancreatitis although the commonest etiological factors are biliary disease and alcohol abuse. In order to assess the incidence of enteroviruses as a cause of acute pancreatitis, large-scale multicenter clinical and virological studies are required, employing some newly developed virological techniques.

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