Viral Signals in Acute Appendicitis: Direct Tissue Infection, Systemic Triggers, and the Unresolved Biology of Spontaneous Resolution.
- 1Department of Hospital Surgery No. 2, Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia.
Abstract
Background/objectives
Acute appendicitis is readily recognised, but its initiating mechanisms remain uncertain. Viral findings are often interpreted without separating direct appendiceal infection, systemic host responses, clinical phenocopies, and virome effects. We examined the evidence for these scenarios and their possible relationship to spontaneous resolution.Methods
A structured narrative synthesis of 82 publications integrated tissue studies, clinical series, epidemiology, microbiome and virome research, natural history, and treatment outcomes.Results
Direct viral injury is documented in rare clinicopathological settings. Available tissue studies argue against frequent direct adenoviral infection. Systemic infection could provoke lymphoid activation, oedema, or early microvascular injury, but this causal sequence has not been demonstrated in humans. Clinical studies document resolution in selected uncomplicated cases, including recovery without antibiotics, without establishing a viral cause.Conclusions
The framework separates observed findings from competing causal hypotheses. A viral prodrome is a candidate research variable whose independent diagnostic and prognostic value remains unestablished. Prospective studies must link infection chronology to local inflammation and subsequent outcomes before such information can guide treatment. Viral symptoms or positive tests cannot justify withholding indicated antibiotics or surgery.
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BibTeX
@article{berikkhanov2026viral,
title = {{Viral Signals in Acute Appendicitis: Direct Tissue Infection, Systemic Triggers, and the Unresolved Biology of Spontaneous Resolution.}},
author = {Zelimkhan Berikkhanov and Kseniya Resnina and Zakhar Akulov and Evgeniy Tarabrin and Alexey Shestakov and Vadim Razumovsky and Aleksey Kotelnikov and Andrey Nikolaev and Milena Ivanova and Sara Nourmahal and Sergey Muraviev},
journal = {Diseases (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/diseases14100361},
url = {https://europepmc.org/article/MED/42929988},
note = {CC BY},
}
RIS
TY - JOUR
TI - Viral Signals in Acute Appendicitis: Direct Tissue Infection, Systemic Triggers, and the Unresolved Biology of Spontaneous Resolution.
AU - Zelimkhan Berikkhanov
AU - Kseniya Resnina
AU - Zakhar Akulov
AU - Evgeniy Tarabrin
AU - Alexey Shestakov
AU - Vadim Razumovsky
AU - Aleksey Kotelnikov
AU - Andrey Nikolaev
AU - Milena Ivanova
AU - Sara Nourmahal
AU - Sergey Muraviev
PY - 2026
DA - 2026/10/01
JO - Diseases (Basel, Switzerland)
DO - 10.3390/diseases14100361
UR - https://europepmc.org/article/MED/42929988
AB - Background/objectives Acute appendicitis is readily recognised, but its initiating mechanisms remain uncertain. Viral findings are often interpreted without separating direct appendiceal infection, systemic host responses, clinical phenocopies, and virome effects. We examined the evidence for these scenarios and their possible relationship to spontaneous resolution.Methods A structured narrative synthesis of 82 publications integrated tissue studies, clinical series, epidemiology, microbiome and virome research, natural history, and treatment outcomes.Results Direct viral injury is documented in rare clinicopathological settings. Available tissue studies argue against frequent direct adenoviral infection. Systemic infection could provoke lymphoid activation, oedema, or early microvascular injury, but this causal sequence has not been demonstrated in humans. Clinical studies document resolution in selected uncomplicated cases, including recovery without antibiotics, without establishing a viral cause.Conclusions The framework separates observed findings from competing causal hypotheses. A viral prodrome is a candidate research variable whose independent diagnostic and prognostic value remains unestablished. Prospective studies must link infection chronology to local inflammation and subsequent outcomes before such information can guide treatment. Viral symptoms or positive tests cannot justify withholding indicated antibiotics or surgery.
SN - 2079-9721
ER -