Hepatitis Delta Virus Infection and Labrea Hepatitis

To the Editor. —In an interesting article, Bensabath et al1suggest that delta virus infection is the preponderant cause of Labrea hepatitis. They declare that the clinical picture of the classic form of massive hepatic necrosis is indistinguishable from the fulminant steatosis observed in Labrea hepatitis. Among the 21 cases histologically examined they found 13 cases with morula cells (Labrea hepatitis), 84% of whom had delta infection. In the eight cases of extensive necrosis there was a 62% incidence of delta infection. The authors conclude that both forms of acute hepatic failure can be attributed to delta infection. There is no doubt that delta infection is prevalent in the region, but this argument is not sufficient to prove that it is the cause of Labrea hepatitis, particularly because delta hepatitis is a worldwide infection known to produce, on occasion, a classic fulminant hepatitis with massive necrosis. Why, then, do