What are the causes of viral pancreatitis?

From the Guidelines

Viral pancreatitis is primarily caused by several viral infections that can directly infect and inflame the pancreas, including mumps virus, coxsackievirus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis viruses, and HIV. The most common viral causes of pancreatitis vary geographically, but certain viruses are more commonly associated with this condition.

• Mumps virus was historically a leading cause before widespread vaccination, but its incidence has significantly decreased in regions with high vaccination rates.
• Other significant viral pathogens include coxsackievirus, CMV, EBV, hepatitis viruses (particularly hepatitis A, B, and E), and HIV, which can directly invade pancreatic tissue or trigger an immune response that damages the pancreas 1. In immunocompromised patients, particularly those with HIV/AIDS, opportunistic viral infections like CMV can more readily cause pancreatitis.
• Certain viral infections may also indirectly lead to pancreatitis by causing biliary obstruction or through systemic inflammatory responses. The pathophysiology typically involves viral replication within pancreatic cells, leading to cell damage, inflammation, and enzymatic autodigestion of pancreatic tissue.
• Treatment is generally supportive, focusing on managing symptoms while the viral infection resolves, though specific antiviral therapy may be indicated in cases of CMV or other treatable viral infections, particularly in immunocompromised patients. It is essential to determine the aetiology of acute pancreatitis, as it can guide treatment and management, with the goal of identifying the cause in 75–80% of cases, and no more than 20–25% should be classified as “idiopathic” 1.

From the Research

Viral Pancreatitis Causes

• Viral infections are a rare cause of acute pancreatitis (AP) 2, 3
• Various viruses can cause pancreatitis, including:
  • Viral hepatitis (A, B, C, D, and E) 2
  • Coxsackie and echoviruses 2, 4
  • Hemorrhagic fever viruses 2
  • CMV 2
  • VZV 2
  • Mumps and measles 2, 5
  • Primary HIV infection 2
  • HSV 2
  • EBV 2
  • Adenovirus 2
  • Influenza H1N1 2
• Immunocompromised patients are more susceptible to viral pancreatitis and have a higher mortality rate 2

Mechanisms of Viral Pancreatitis

• Viral entry into pancreatic cells triggers inflammation, immune response activation, and enzymatic autodigestion, leading to tissue damage and potential complications 6
• Trypsinogen activation in acinar cells caused by viral infection can lead to acute pancreatitis 6

Diagnosis and Management

• Advanced diagnostic tests such as PCR, in situ hybridization, and biopsy can help in understanding the role of viruses in causing acute pancreatitis 3
• Timely diagnosis, treatment, and management of pancreatitis are crucial for improving patient outcomes 3