Liver and intrahepatic bile ducts - nontumor
Viral hepatitis
Hepatitis delta agent (hepatitis D)

Topic Completed: 1 May 2012

Revised: 23 January 2019, last major update May 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Hepatitis D[TI] liver[TIAB] full text[sb]

Komal Arora, M.D.
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Cite this page: Arora K. Hepatitis delta agent (hepatitis D). website. Accessed February 27th, 2020.
Definition / general
  • Only occurs with hepatitis B virus because delta agent is a defective RNA virus that requires hepatitis B infection for its own replication
  • May cause any clinical syndromes or histologic patterns of hepatitis B
  • May also cause an acute hepatitis with atypical biphasic pattern or a chronic hepatitis that progresses rapidly to cirrhosis in 15% of patients
  • Consider delta virus infection if (a) recurrent acute hepatitis or (b) sudden fulminant hepatitis in chronic hepatitis B carrier
  • Diagnosis: serology
Microscopic (histologic) description
  • Typical histology of hepatitis B infection
  • May also show morule cell (multivesicular change due to vacuoles in infected hepatocytes) and more pronounced necrosis and inflammatory activity
Microscopic (histologic) images

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Lobular and portal
with fatty

Acidophil bodies

Immunostains for HBV surface antigen

Immunostain for HDV antigen (nuclear localization)

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