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April 26, 1985

Fulminant Delta Hepatitis in Chronic Asymptomatic HBsAg Carriers

JAMA. 1985;253(16):2362-2363. doi:10.1001/jama.1985.03350400044009

To the Editor.—  In a recent issue of The Journal, De Cock et al1 presented two cases of fulminant delta hepatitis in two male homosexual patients with chronic hepatitis B virus (HBV) infection. We followed up prospectively, for at least six months, 546 adults with acute sporadic hepatitis B surface antigen (HBsAg)-positive hepatitis who were hospitalized at the Athens Hospital for Infectious Diseases, Greece, between May 1981 and May 1983. Using a sensitive enzyme immunoassay (Corzyme M) for the determination of the core antigen of HBV (anti-HBc IgM) we found that 43 (7.9%) of the 546 patients were anti-HBc IgM negative. These patients were considered as asymptomatic chronic HBsAg carriers with a superimposed acute non-B hepatitis.2Twenty-two (51.2% ) of the 43 cases were diagnosed as having delta antigen superinfection, using sensitive radioimmunoassays for the detection of delta antigen, anti-delta IgG, and anti-delta IgM.3,4 Homosexual promiscuity and parenteral