title: Virological and histological re-evaluation of Labrea hepatitis.
abstract: BACKGROUND
  a peculiar form of fulminant hepatitis known as Labrea hepatitis, probably related to hepatitis B and D, has been reported in Brazilian Amazon as early as the 1930s.
  
  
  METHODS
  we reviewed the postmortem liver biopsies of 9 patients with Labrea Hepatitis. Immunostaining for HBV and HDV antigens were performed.
  
  
  RESULTS
  we found several important characteristics in the liver tissues: 1) moderate hepatocellular necro-inflammation, 2) hepatocellular ballooning, 3) ballooned hepatocytes with fat droplets surrounding the nucleus (morula-like cells or spongiocytes), 4) mild to moderate necrosis and/or mild portoseptal fibrosis. Hepatitis B surface antigen (HBsAg) was identified in 7 of the 9 cases and was concentrated in the Morula-like cells. Hepatitis B core antigen (HBcAg) was present in 5 cases, mostly in the hepatocyte's nucleous. The hepatitis D virus antigen (HDV Ag) was present in 5 cases, mostly in the cytoplasm and concentrated in the Morula-like cells.
  
  
  CONCLUSIONS
  labrea hepatitis is a fatal disease mostly affecting isolated communities in the Amazon. Evidence implicates HBV and HDV in the etiology of this disease, but this hypothesis needs to be confirmed with genotyping and sequencing research on HBV DNA and HDV RNA extracted from the liver and sera of these patients.
authors.affiliation: Gastro-Hepatology Unit, Federal University of Bahia, Brazil. unif@svn.com.br
authors.forename: Raymundo
authors.initials: R
authors.lastname: Paraná
authors.forename: Zilton
authors.initials: Z
authors.lastname: Andrade
authors.forename: Luiz Antônio R
authors.initials: LA
authors.lastname: de Freitas
authors.forename: Aluizio
authors.initials: A
authors.lastname: Prata
authors.forename: Alan
authors.initials: A
authors.lastname: Kay
authors.forename: Joâo Barberino
authors.initials: JB
authors.lastname: Santos
mesh_terms: D000293:Adolescent; D001344:Autopsy; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000473:pathology* / Q000821:virology*; D006512:Hepatitis B Core Antigens / Q000032:analysis; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D003699:Hepatitis D / Q000276:immunology / Q000473:pathology* / Q000821:virology*; D035923:Hepatitis delta Antigens / Q000032:analysis; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008297:Male; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D035923:Hepatitis delta Antigens