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Hepatitis and Salivary Swelling (Sialadenitis and Hepatitis)

last modified on: Fri, 03/16/2018 - 08:43

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Background

Viruses known to be associated with salivary gland swelling include paramyxovirus (causing mumps), human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpes simplex virus (HHSV-8), hepatitis C virus (HVC), human papilloma virus (HPV), cocksackie virus, influenza virus and echovirus.(Schreiber 2009)

Hepatitis C virus (HCV) infection has been estimated to affect 170 million people worldwide with a prevalence in the United States of ~ 2% of the adult population during the later part of the 20th century (Alter et al 1999). Chronic hepatitis C can lead to cirrhosis and hepatocellular carcinoma.

Extrahepatic manifestations (EHMs) of HCV occur in 40-75% of patients with chronic HCV infectionand demonstrate at least one clinical EHM. Although HCV may effect other cells outside of the liver, most EHMs are thought to be autoimmune as a secondary-host-immune response to the viral infection and not a direct viral effect. 

The association between sialadenitis and HCV infection was first reported in 1992 (Haddad 1992) and has been estimated to produce an HCV-related sicca syndrome with chronic HCV with the large range (4 to 57%) ascribed to differences in diagnostic critera. The virus has not been demonstrated to directly infect salivary gtland tissue - and the sialadenitis ascribed to HCV is throught to be due to a host-immune mediated effect (Ko 2012).  

A viral etiology to Sjogrens syndrome has been postulated - but inconclusive. The term "Sjogren's syndrome secondary to chronic HCV infection" has been suggested to differentiate between the two entities. (Carrozzo 2008)

References

Ko HM, Hernandez-Prera JC, Zhu H, Dikman SH, Sidhu HK, Ward SC, thung SN: Morphologic features of extrahepatic manifestation of hepatitis C virus infection. Clin Dev Immunol 2012; 2012740138. doi:10.1155/2012/740138

Alter MJ,  Kruszon-Moran D, nainan OV, et al The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. The New England Journal of Medicine. 1999;3421(8):556-562

Haddad J, Deny P, Munz-Gotheil C, et al. Lymphocytic sialadenitis of Sjogren’s syndrome associated with chronic hepatitis C virus liver disease. The Lancet. 1992;339(8789):321–323

Schreiber A and Hershman G: Non-HIV Viral Infections of the Salivary Glands 2009  in Oral and Maxillofacial Surgery Clinics Volume 21, Issue 3

Carrozzo M: Oral diseases associated with hepatitis C virus infection. Part 1. Sialadenitis and salivary glands lymphoma. Oral Dis. 2008 Mar;14(2):123-30