Labrea fever

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Lábrea fever
Other names: Lábrea's black fever, Lábrea hepatitis, Santa Marta fever
SpecialtyInfectious disease
Usual onsetSudden
DurationApprox. 1 week
PreventionHBV vaccination
PrognosisUsually fatal

Lábrea fever is a severe infection of the liver, in which hepatitis D infects people who already have hepatitis B.[1][2] It presents with sudden symptoms of hepatitis.[3] It progresses to severe liver damage and has a high chance of developing liver cancer and liver failure.[2]

Vaccination against hepatitis B plays an important role in preventing the disease.[3]

It affects particularly children.[3]

The condition was formally known as Labrea black fever. In 1987 it was confirmed that it was fulminant hepatitis caused by super-infection of the hepatitis D in people with hepatitis B.[1]

Signs and symptoms

Lábrea fever has a sudden onset, with jaundice, anorexia (lack of appetite), hematemesis (vomiting of blood), headache, fever and severe prostration. Death occurs by acute liver failure (ALF). In the last phase, neurological symptoms such as agitation, delirium, convulsions and hemorrhagic coma commonly appear. These symptoms arise from a fulminant hepatitis which may kill in less than a week, and which characteristically affects children and yousng adults, and more males than females. It is accompanied also by an encephalitis in many cases.[4]


Steatosis (microvesicular) Inset-macro

Labrea fever is now known to be a coinfection or superinfection of hepatitis B (HBV) with hepatitis D (genotype 3[5]).[4]

Infected individuals show extensive destruction of liver tissue, with steatosis of a particular type (microsteatosis, characterized by small fat droplets inside the cells), and infiltration of large numbers of inflammatory cells, comprised mainly by macrophages containing delta virus antigens.[4][5]


In terms of the diagnosis of this condition we find that only via the presence of antibodies against HDV or HDV RNA, as well as via the presence of antibodies against HBV or HBV RNA can the infection be positively determined.[6][7]


The disease is highly lethal: in a study carried out in 1986 at Boca do Acre, also in the Amazon, 39 individuals out of 44 died in the acute phase of the disease.[4]


In the 1987 Boca do Acre study, scientists did an epidemiological survey and reported delta virus infection in 24% of asymptomatic HBV carriers, 29% of acute nonfulminant hepatitis B cases, 74% of fulminant hepatitis B cases, and 100% of chronic hepatitis B cases.[4] The delta virus seems to be endemic in the Amazon region.[8]


Amazon basin, South America

It was first discovered in the 1950s in the city of Lábrea, in the Brazilian Amazon basin, where it occurs mostly in the area south of the Amazon River, in the states of Acre, Amazonas, and Rondônia; the disease has also been diagnosed in Colombia and Peru.[9]


  1. 1.0 1.1 Oliveira, Marcelo Siqueira de; Valle, Suiane da Costa Negreiros do; Souza, Rodrigo Medeiros de; Silva, Romeu Paulo Martins; Figueiredo, Elisabeth Níglio de; Taminato, Mônica; Fram, Dayana (20 December 2017). "Scientific evidence on hepatitis Delta in Brazil: integrative literature review" (PDF). Acta Paul Enferm. 30 (6): 658–666. doi:10.1590/1982-0194201700091. ISSN 1982-0194.
  2. 2.0 2.1 Berman, Jules J. (2012). "43. Group V viruses: single stranded - sense RNA". Taxonomic Guide to Infectious Diseases: Understanding the Biologic Classes of Pathogenic Organisms. London: Academic Press. p. 254. ISBN 978-0-12-415895-5.
  3. 3.0 3.1 3.2 Hoofnagle, Jay H. (2012). "5. Delta hepatitis and the hepatitis delta virus". In Seeff, Leonard B.; Lewis, James H. (eds.). Current Perspectives in Hepatology: Festschrift for Hyman J. Zimmerman, M.D. New York: Springer. pp. 56–58. ISBN 978-1-4684-7043-7. Archived from the original on 2021-12-11. Retrieved 2021-12-07.
  4. 4.0 4.1 4.2 4.3 4.4 Bensabath G, Hadler SC, Soares MC, Fields H, Dias LB, Popper H, Maynard JE (1987). "Hepatitis delta virus infection and Labrea hepatitis. Prevalence and role in fulminant hepatitis in the Amazon Basin". JAMA. 258 (4): 479–83. doi:10.1001/jama.1987.03400040077025. PMID 3599343.
  5. 5.0 5.1 Schiff, Eugene R.; Maddrey, Willis C.; Reddy, K. Rajender (29 November 2017). Schiff's Diseases of the Liver. John Wiley & Sons. p. 620. ISBN 978-1-119-25122-4. Archived from the original on 11 December 2021. Retrieved 5 December 2021.
  6. "What is Hepatitis D - FAQ | CDC". 3 December 2020. Archived from the original on 5 November 2021. Retrieved 13 December 2021.
  7. Song, Jeong Eun; Kim, Do Young (2016). "Diagnosis of hepatitis B". Annals of Translational Medicine. 4 (18): 338. doi:10.21037/atm.2016.09.11. ISSN 2305-5839. Archived from the original on 15 December 2021. Retrieved 14 December 2021.
  8. Rizzetto, Mario (2015). "Hepatitis D Virus: Introduction and Epidemiology". Cold Spring Harbor Perspectives in Medicine. 5 (7): a021576. doi:10.1101/cshperspect.a021576. ISSN 2157-1422. Archived from the original on 11 December 2021. Retrieved 11 December 2021.
  9. Bensabath, Gilberta; Soares, Manoel do Carmo Pereira (2004). "[The evolution of knowledge about viral hepatitis in Amazon region: from epidemiology and etiology to the prophilaxy]". Revista Da Sociedade Brasileira De Medicina Tropical. 37 Suppl 2: 14–26. doi:10.1590/s0037-86822004000700003. ISSN 0037-8682. Archived from the original on 21 August 2020. Retrieved 11 December 2021.