CHOLANGITIS IN VIRAL DISEASE

This review of biliary manifestations of viral diseases includes aspec ts of morphologic diagnosis, therapeutic implications, prognostic effe ct, and natural history. The viral causes of cholangitis are reviewed, with subclassification on the basis of primary hepatic versus systemi c infections and immune competence of the host. Special attention is g iven to the histopathologic and clinical features of viruses affecting the biliary tree. Among hepatotropic viruses, hepatitis C more freque ntly is associated with cholangitis than is hepatitis B, In both hepat itis B and hepatitis C, the lymphocytic cholangitis duct damage is rev ersible and does not adversely influence the course of disease or resp onse to therapy, Hepatitis A and hepatitis E, despite causing clinical cholestasis, do not result in severe cholangitis, The effect of syste mic viruses on the biliary tree is primarily dependent on the status o f the host immune system. Infants and severely immunosuppressed patien ts (such as those who have undergone liver transplantation) are at ris k for cytomegalovirus cholangitis, whereas patients with late-stage ac quired immunodeficiency syndrome (AIDS) are at risk for cholangitis du e to numerous organisms. Overall, cholangitis attributable to viral di sease encompasses a wide spectrum of clinicopathologic scenarios, depe nding on the;etiologic virus and the immune competence of the host.