Hepatitis Testing
Which assays are most commonly used to diagnose HBV?
-Enzyme Immonassay -Chemiluminescent immunoassay -NOT molecular!!!
HCV detection
-POSitive anti-HCV screening Test -Confirmatory serologic test: RIBA
What does the presence of Anti-Hbs indicate?
-indicates recovery or immunity
What does the presence of HbsAg indicate?
-indicator of infection/infectivity
What does the presence of Anti-HBc Total (IgG & IgM) indicate?
-lifelong marker -indicates past, present, or chronic infection
What is the incubation period for Hepatitis B?
50-150 days
An outbreak of jaundice occurs in several young children who attend the same day care center. If the outbreak was caused by a virus, which one of the following is the most likely cause? A) Hepatitis A virus B) Hepatitis B virus C) Hepatitis C virus D) Hepatitis D virus
A
The presence of HbsAg, anti-HBc and often HbeAg is characteristic of: A) early acute phase HBV hepatitis B) early convalescent phase HBV hepatitis C) recovery phase of acute HBV patients D) past HBV infection
A
The serum of an individual who received all doses of the hepatitis B vaccine should contain: A) anti-HBs B) anti-HBe C) anti-HBc D) all of the above
A
What is the expected serological response of an immunocompetent individual who has been vaccinated for Hepatitis B? A) HBsAg (NEGative); Anti-HBc (NEG); Anti-HBs (POSitive) B) HBsAg (POSitive); Anti-HBc (POSitive); Anti-HBs (NEGative) C) HBsAg (NEGative); Anti-HBc (POSitive); Anti-HBs (POSitive) D) HBsAg (NEGative); Anti-HBc (POSitive); Anti-HBs (POSitive)
A
Which hepatitis B marker is the best indicator of early acute infection? A) HBsAg B) HBeAg C) Anti-HBc D) Anti-HBs
A) HBsAg Hepatitis B surface antigen (HBsAg) is the first marker to appear in hepatitis B virus infection. It is usually detected within four weeks of exposure (prior to the rise in transaminases) and process for about three months after serum enzyme levels return to normal.
All of the following hepatitis viruses are spread through blood or blood products except: A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D
A) Hepatitis A Hepatitis A is spread through the fecal-oral route and is the cause of infectious hepatitis. Hepatitis A virus has a shorter incubation. (2-7 weeks) than hepatitis B virus (1-6 months). Epidemics of hepatitis A virus can occur, especially when food and water become contaminated with raw sewage. Hepatitis E virus is also spread via the oral-fecal route and, like hepatitis A virus, has a short incubation period.
Which feature is characteristic of chronic hepatitis due to HBV? A) It is more likely to occur if infection occurs in adults B) Seroconversion from HBeAg positive to HBeAg negative after four months of interferon-alpha therapy is 40% C) Long-term therapy with steroids is also effective D) The likelihood of responding to interferon is greater in patients with high levels of HBV DNA
A) It is more likely to occur if infection occurs in adults The likelihood of chronicity after acute HBV infection varies as a function of age. Infection at birth is associated with a 90% chance of chronic infection; infection in young adulthood in immunocompetent persons is associated with an approximately 1% risk of chronicity. The likelihood of responding to interferon is greater in patients with moderate to low levels of HBV DNA and in patients with substantial elevations of aminotransferase activity. In patients with HPV, long-term therapy with glucocorticoids is ineffective and detrimental. (Braunwald, 15/e p 1744)
The presence of HbsAg, anti-HBc and often HbeAg is characteristic of: A) early acute phase HBV hepatitis B) early convalescent phase HBV hepatitis C) recovery phase of acute HBV hepatitis D) past HBV infection
A) early acute phase HBV hepatitis The markers listed appear early during hepatitis B infection; HBsAg and HBeAg disappeared prior to convalescence and recovery. [Stevens 2017, p412]
The classic antibody response pattern following infection with hepatitis A is: A) increase in IgM antibody--> decrease in IgM antibody--> increase in IgG antibody B) detectable presence of IgG antibody only C) detectable presence of IgM antibody only D) decrease in IgM antibody--> increase in IgG antibody of the IgG3 subtype
A) increase in IgM antibody--> decrease in IgM antibody--> increase in IgG antibody The immune response to HIV follows the classic pattern for antibody response, with IgM appearing first, followed by a decline in IgM and appearance of IgG. [Mahon 2006, p 118]
Vaccines do this, that's the trick...
Anti-HBs no more sick
An individual with hepatomegaly, jaundice, and elevated liver enzymes has the following laboratory results: IgM anti-HAV (negative), HBsAg (positive), IgM anti-HBc (positive), and anti-HCV (negative). These findings support a diagnosis of: A) hepatitis A B) acute hepatitis B C) chronic hepatitis B D) hepatitis C
B
If a patient developed immunity to a viral infection then he/she would be expected to have which of the following serology results? A) IgM POSitive, IgG NEGative B) IgM NEGative, IgG POSitive C) IgM POSitive, IgG POSitive D) IgM NEGative, IgG NEGative
B
You think your patient may be in the "window period" of hepatitis B virus (HBV) infection because his blood tests for HBs antigen and anti-HBs antibody are negative. Which one of the following additional tests is MOST useful to establish that he has been infected with HBV and is in the "window period"? A) HBe antigen B) Anti-HBc antibody C) Anti-HBe antibody D) Delta antigen
B
A 30-year-old man comes to your office with complaints of fatigue, anorexia, nausea, and vomiting. He does not have fever. His urine is dark. On physical examination, his liver is slightly enlarged and minimally tender. He does not have edema or spider angiomata. Laboratory tests show the following: negative HBsAg, negative IgM anti-HAV positive IgM anti-HBc, and negative anti-HCV. The most likely diagnosis is: A) Acute hepatitis A B) Acute hepatitis B C) Acute hepatitis A and B D) Chronic hepatitis B E) Acute hepatitis C
B) Acute hepatitis B In this case, the patient has acute HBV infection signaled by the positive IgM antiaging BC. Because the HBsAg is negative, it is likely below the threshold for detection. The IgM response reflects recent infection. This serologic parent does not fit with infection with any of the other hepatitis viruses. The symptoms and signs, lack of fever, and minimal abnormal findings on examination of the liver are consistent with the diagnosis of acute HBV. (Braunwald, 15/e, p 1730)
Which is the first antibody detected in serum after infection with hepatitis B virus (HBV)? A) Anti-HBs B) Anti-HBc IgM C) Anti-HBe D) All are detectable at the same time
B) Anti-HBc IgM Antibody to the hepatitis B core antigen (anti-HBc) is the first detectable hepatitis B antibody. It persists in the serum 41-2 years postinfection and is found in the serum of asymptomatic carriers of HPV. Because levels of total anti-HBc are high after recovery, IgM anti-HBc is a more useful marker for acute infection. Both anti-HBc and anti-HBs can persist for life, but only anti-HBs is considered protective.
After passing his physical examination, a 19-year-old army recruit gives urine and blood samples for further testing. Serum analysis yields ALT, HBsAg, HBeAg,Anti-HBc, and bilirubin. All other values are normal. What is the Hepatitis B status of this recruit? A) Asymptomatic carrier B) Chronic active carrier C) Fulminant HBV D) Recovered from acute self-limited HBV e. Vaccinated against HBV
B) Chronic active carrier The presence of elevated ALT, HBsAg, anti-HBc, HBeAg, and bilirubin all point to active Hepatitis B
Which one of the hepatitis viruses is a DNA virus? A) HAV B) HBV C) HCV D) HEV E) HGV
B) HBV HBV is a DNA virus belonging to the Hepadnaviridae. It possesses partially single-stranded and partially double-stranded DNA and a double-shelled virion. Its major antigens are HBsAg, a surface protein, and HBcAg and HBeAg, both core proteins. The other hepatitis viruses are RNA viruses belonging to different genera and species. (Braunwald 15/E, p 1723)
The antigen marker most closely associated with transmissibility of HPV infection is: A) HBsAg B) HBeAg C) HBcAg D) HBV
B) HBeAg HBeAg is present in patient serum during periods of active HBV replication, and is therefore a marker of high infectivity. [Stevens 2017, p 415]
The persistence of which marker is the best evidence of chronic HBV infection? A) HBeAg B) HBsAg C) anti-HBe D) anti-HBs
B) HBsAg The persistence of surface antigen is an excellent indicator of chronicity. With acute infection and resolution surface antigen peaks 2-3 months post-infection and before symptoms, but is completely gone before 6 months, to be replaced by anti-surface antibody (HBsAb) and the clinical symptoms of acute hepatitis. In chronic infection the surface antibody does not appear, while the surface antigen persists. [QCClinPath 3e 2014, p88]
Which immunoglobulin appears first in the primary immune response? A) IgG B) IgM C) IgA D) IgE
B) IgM The first antibody to appear in the primary immune response to an antigen is IgM. The titer of antiviral IgM (e.g., IgM antibody to cytomegalovirus [anti-CMV]) is more specific for acute or active viral infection than IgG and may be measured to help differentiate active from prior infection.
A 28-year-old man complains of some fatigue and slight RUQ tenderness. His laboratory examination shows the following hepatitis B profile: positive HBsAg, negative HBs, positive anti-HBe, and negative HBeAg. The likely diagnosis is: A) Acute HBV infection, high infectivity B) Late-acute HBV, low infectivity C) Recovered from HBV infection D) Chronic HBV infection, high infectivity E) Immunization with HBsAg vaccine
B) Late-acute HBV, low infectivity This patient has clinical features in a serological pattern consistent with the diagnosis late acute HBV infection of low infectivity (or chronic HBV infection of low infectivity) characterized by anti-HBe and -HBsAg, but negative anti-HBs and anti-HBeAg. A small window exists at about 24 to 26 weeks after the onset of illness when the HBsAg level declines, but before anti-HBs appears, and after HBeAg disappears and anti-HBe appears that marks the progression of HBV infection and signals a late acute infection with low infectivity or the low infectivity stage of chronic HBV infection. After that point, anti-HBs appears and progressively increases and anti-HBe process. (Braunwald, 15/E, p 1724)
What essay would confirm the immune status to hepatitis B virus? A) HBsAg B) anti-HBs C) IgM anti-HBcAg D) hepatitis C Ag
B) anti-HBs Antibody to the surface antigen of hepatitis B virus (anti-HBs) is the major protective antibody and hepatitis B and provides evidence of immunity against this infection. [Turgeon 2009, p 283]
Chronic carriers of HBV: A) have chronic symptoms of hepatitis B) continue to carry HBV C) do not transmit infection D) carry HBV but are not infectious
B) continue to carry HBV some patients who become infected with HPV do not develop immunity and become long-term carriers of the virus who can transmit the infection to others. [Turgeon 2009, p 284]
A 26-year-old nurse developed fatigue, a low-grade fever, polyarthritis and urticaria. Two months earlier she had cared for a patient with hepatitis. Which of the following findings are likely to be observed in this nurse? A) a negative hepatitis B surface antigen test B) elevated AST and ALT levels C) a positive rheumatoid factor D) a positive Monospot test
B) elevated AST and ALT levels the nurses history and symptoms suggest that she has hepatitis. The liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are elevated in hepatitis as general indicators of liver inflammation. [Stevens 2017, p 412]
Which of the following is the best indicator of an acute infection with hepatitis A virus? A) the presence of IgG antibodies to hepatitis A virus B) the presence of IgM antibodies to hepatitis A virus C) a sharp decline in the level of IgG antibodies to hepatitis A virus D) a rise in both IgM and IgG levels of antibody to hepatitis A virus
B) the presence of IgM antibodies to hepatitis A virus IgM is the first antibody to be produced during an immune response, and levels decline within 6-12 months; it is therefore an indicator of a current infection. [Stephen 2017, p411]
Each of the following statements concerning HCV and HDV is correct EXCEPT: A) HCV is an RNA virus that causes post-transfusion hepatitis B) HDV is a defective virus that can replicate only in a cell that is also infected with HBV. C) HDV is transmitted primarily by the fecal-oral route D) People infected with HCV commonly become chronic carriers of HCV and are predisposed to hepatocellular carcinoma
C
Each of the following statements concerning hepatitis C virus (HCV) and hepatitis D virus (HDV) is correct EXCEPT: A) HCV is an RNA virus that causes post-transfusion hepatitis. B) HDV is a defective virus that can replicate only in a cell that is also infected with hepatitis B virus. C) HDV is transmitted primarily by the fecal-oral route. D) People infected with HCV commonly become chronic carriers of HCV and are predisposed to hepatocellular carcinoma.
C
A 35-year-old woman comes to your office with complaints of fatigue, anorexia, nausea, and vomiting. She does not have fever. Her urine is dark in her stool is clay colored. On physical examination, her liver is slightly enlarged and minimally tender. She does not have edema or spider angiomata. Laboratory tests are the following: negative HBsAg, positive IgM anti-HAV, positive IgM anti-HBc, and negative anti-HCV. The most likely diagnosis is: A) Acute hepatitis A B) Acute hepatitis B C) Acute hepatitis A and B D) Chronic hepatitis B E) Acute hepatitis C
C) Acute hepatitis A and B this patient has both hepatitis A and B virus infections. Both viruses can infect the same person. Clinical findings are consistent with an acute hepatitis; they are not specific for one virus. The positive IgM anti-HAV and the positive IgM anti-HBC are evidence of acute infection with both viruses. The negative HBsAg is consistent with this antigen being below the threshold of detection. (Braunwald, 15/e, p 1730)
In hepatitis B virus infection, which one the following antibodies is the protective antibody? A) Anti-HBe B) Anti-HBc C) Anti-HBs D) Anti-polymerase E) Anti-HBV DNA
C) Anti-HBs Anti-HBs is the protective antibody in hepatitis B virus infection. Persons with anti-HBs are protected against reinfection with the virus. None of the other antibodies are protected. However, anti-HBe and -HBC are commonly measured to gauge the progress of the infection determine the status of the patient with a viral hepatitis. (Braunwald, 15/e, p 1723)
Transmission of hepatitis A is almost exclusively by: A) Blood transfusion B) Intravenous drug abuse C) Fecal-oral route D) Sexual
C) Fecal-oral route Hepatitis A virus (HAV) is transmitted solely by the fecal-oral route. Person-to-person spread of HAV is enhanced by poor personal hygiene and overcrowding. Large outbreaks, as well as sporadic cases, have been traced to consuming contaminated food, water, milk, and shellfish. Intrafamily and institutional spread are common also. It is not spread by blood transfusion and sexual contact. (Braunwald, 15/e, p 1728)
Which of the hepatitis viruses most commonly progresses to chronic infection and chronic hepatitis? A) HAV B) HBV C) HCV D) HEV E) HGV
C) HCV HCV progresses to chronic infection,. About 50 to 70% of persons infected develop chronic hepatitis. About 80 to 90% develop chronic infection. HBV progresses to chronic infection in children and adults in less than 10% of cases; however, neonates do so commonly. HAV and HEV do not progress to chronic infection. (Braunwald, 15/E, p 1747)
Which of the Hepatitis viruses has a confirmatory serologic test? A) HAV: Reba TV show B) HBC: RIBA C) HCV: RIBA D) HDV: RIBA E) HEV: RIBA
C) HCV: RIBA
Which one of the following disorders of bilirubin metabolism shows increased unconjugated bilirubin, increased conjugated bilirubin, and positive bilirubin in the urine? A) Neonatal jaundice B) Crigler-Najjar syndrome, types I and II C) Hepatitis D) Gilbert's syndrome E) Ineffective erythropoiesis
C) Hepatitis This case shows the laboratory findings and hepatitis. In Crigler-Najjar syndrome and neonatal jaundice, the conjugated bilirubin is low and no bilirubin is found in the urine. In Gilbert's syndrome and ineffective erythropoiesis, the conjugated bilirubin is low and normal, respectively, and no bilirubin is found in the urine. (Braunwald, 15/E, P256)
A 55-year-old woman manager of a regional long-distance telephone office when you examine for the first time feels well. You do a complete physical examination, which is normal except for a few very small palpable and movable, nontender notes in both cervical chains and occasional wheezes in the lungs. However, her laboratory studies show the following hepatitis B virus profile: negative HBsAg, positive anti-HBs, low levels of IgG anti-HBc, negative anti-HBeAg, and positive anti-HBe. The likely diagnosis is: A) Acute HBV infection, high infectivity B) Late-acute HBV, low infectivity C) Recovered from HBV infection D) Chronic HBV infection, high infectivity E) Immunization with HBsAg vaccine
C) Recovered from HBV infection The serologic pattern in this case is a person who has recovered from HBV infection. They possess anti-HBs, the protective antibody in HBV infection, IgG anti-HBc, and anti-HBc. The anti-HBc may be positive or negative in person to recover from HBV. (Braunwald, 15/80, p 7031)
Which serological marker of HBV (hepatitis B virus) infection indicates recovery and immunity? A) viral DNA polymerase B) HBe antigen C) anti-HBs D) HBsAg
C) anti-HBs Antibodies to the surface antigen of hepatitis B virus (anti-HBs) appears after the acute stage of infection during convalescence and as a marker of recovery and immunity, while the other markers listed are components of the virus itself. [Turgeon 2009, p 283]
Hepatitis C differs from hepatitis A because it: A) has a highly stable incubation. B) is associated with a high incidence of icteric hepatitis C) is associated with a high incidence of the chronic carrier state D) is seldom implicated in cases of post-transfusion hepatitis
C) is associated with a high incidence of the chronic carrier state About 85% of persons infected with HCV will develop a chronic infection, while hepatitis A does not progress to a chronic state. [Stephen 2017, p 418]
Which of the following statements regarding infection with hepatitis D virus is true? A) occurs in patients with HIV infection B) does not progress to chronic hepatitis C) occurs in patients with hepatitis B D) is not spread through blood or sexual contact
C) occurs in patients with hepatitis B Hepatitis D virus is an RNA virus that requires the surface antigen or envelope of the hepatitis B virus for entry into the hepatocyte. Consequently, hepatitis D virus can infect only patients who are co-infected with hepatitis B.
The disappearance of HBsAg and HBeAg, the persistence of anti-HBc, the appearance of anti-HBs, and often of anti-HBe indicate: A) early acute HBV hepatitis B) early convalescent phase HBV hepatitis C) recovery phase of acute HBV hepatitis D) carrier state of acute HBV hepatitis
C) recovery phase of acute HBV hepatitis Anti-HBs and anti-HBe are associated with recovery and development of immunity in hepatitis B, while HBsAg and HBeAg are antigens from HBV that are present during the infectious stages of disease. [Stevens 2017, p412]
The enzyme-linked immunosorbent assay (ELISA) technique for the detection of HBsAg: A) requires radio labeled C1q B) is quantitated by degree of fluorescence C) uses anti-HBs linked to horseradish peroxidase D) uses beads coated with HBsAg
C) uses anti-HBs linked to horseradish peroxidase The ELISA for HBsAg is a sandwich technique in which HBsAg in patient serum binds to anti-HBs on a solid phase; the HBsAg is then detected by the addition of an anti-HBs labeled with an enzyme. [Stevens 2017, p 415]
The 20-nm spheres and filamentous structures of HBV are: A. infectious B. circulating aggregates of HBcAg C. circulating aggregates of HBsAg D. highly infectious when present in great abundance
C. circulating aggregates of HBsAg These structures, which consist entirely of HBsAg, circulate in the serum but are not infectious since they lack the other viral components. [Turgeon 2009, p 282]
A woman who is hepatitis B surface antigen (HBsAg) positive and hepatitis B surface antibody (HBsAb) negative has just given birth. Which one of the following is the most appropriate thing to do for the newborn? A) Nothing. The child is protected against Hepatitis B B) Immunize with vaccine containing HBsAg (HBV vaccine) C) Give Hepatitis B hyperimmune globulin (HBIG) D) Give both the HBV vaccine and HBIG
D
Quantitative tests for HCV RNA are used to: A) screen for hepatitis C B) determine the HCV genotype C) differentiate acute HCV infection from chronic HCV infection D) monitor hepatitis C patients on antiviral therapy
D
Which hepatitis antibody confers immunity against reinfection with HBV? A) Anti-HBc IgM B) Anti-HBc IgG C) Ant-HBe D) Anti-HBs
D
Which of the following hepatitis viruses is transmitted by the fecal-oral route? A) Hepatitis B B) Hepatitis C C) Hepatitis D D) Hepatitis E
D
Your patient is a 35-year old man who complains that the whites of his eyes have turned yellow. After taking a history and doing a physical, you order serologic tests to determine whether he has viral hepatitis. On the basis of the results, you tell him that he has a mild form of hepatitis that does not cause long term damage to the liver. Your conclusion is based on a positive result on which one of the following tests? A) Antibody to hepatitis C virus B) Hepatitis B surface Antigen C) Hepatitis delta antigen D) IgM antibody to hepatitis A virus
D
Hepatitis B virus can be transmitted by: A) Acupuncture B) Tattoos C) Sexual contact D) All of these options
D) All of these options Although the most common mode of transmission of hepatitis B is via needle puncture, it may also be transmitted by other parenteral means, including sexual transmission in contact with contaminated blood through broken skin or mucous membranes.
If only anti-HBs is positive, which of the following can be ruled out? A) HBV vaccination B) Distant past infection with HBV C) Hepatitis B immunoglobulin (HBIG) injection D) Chronic HBV infection
D) Chronic HBV infection Persons with chronic HBV infection show a positive test result for anti-HBc (IgG or total) and HbsAg, but not anit-HBs. Patients with active chronic hepatitis have not become immune to the virus
A 51-year-old man healthcare worker whom you examined for the first time feels well. You do a complete physical examination, which is normal except for slightly overweight and borderline hypertension. It is interesting that his laboratory studies show the following hepatitis B virus profile: positive HBsAg, negative anti-HBs, low levels of IgG anti-HBc, positive anti-HBeAg, and negative anti-HBe. The likely diagnosis is: A) Acute HBV infection, high infectivity B) Late-acute HBV, low infectivity C) Recovered from HBV infection D) Chronic HBV infection, high infectivity E) Immunization with HBsAg vaccine
D) Chronic HBV infection, high infectivity The positive HBsAg in hepatitis B virus infection, together with low levels of IgG anti-HBc, positive HBeAg, and negative anti-HBe, fit the picture of chronic HBV infection with high infectivity. In chronic or late-acute HBV low infectivity, the HBeAg would be negative. Persons immunized with HPV vaccine show only anti-HBs. Persons who have recovered from HBV infection are negative for HBsAg. (Braunwald, 15/E, p 1731)
The following procedure has been routinely used protection of hepatitis B surface antigen (HBsAg) because of its high level of sensitivity: A) hemagglutination B) counterimmunoelectrophoresis C) radial immunodiffusion D) ELISA
D) ELISA Of all the myth methods listed, ELISA is the most sensitive and the only one that is used for detection of HBsAg in the clinical laboratory. [Stevens 2017, p 415]
What constitutes a diagnosis of viral hepatitis? A) abnormal test results for liver enzymes B) clinical signs and symptoms C) positive results for hepatitis markers D) all of the others
D) all of the others To diagnose a case of hepatitis, the physician must consider clinical signs as well as laboratory tests that measure liver enzymes and hepatitis markers.
Fill in the Blank: Retroviruses, including HIV, are RNA viruses that use a DNA intermediate to replicate their genomes. In contrast, hepatitis B virus (HBV) is a ________ virus that uses an RNA intermediate to replicate its genome
DNA
The most sensitive indicator of infection with hepatitis C virus (HCV) is: A) Anti-HCV, first generation assay against C100-3 B) B) Anti-HCV, second generation assay against C200 and C22-3 C) Anti-HCV, third-generation assay against C200, C22-3, and NS5 D) Anti-envelope proteins E2/NS1 E) HCV RNA
E) HCV RNA Most sensitive indicator of HCV infection is measurement of HCV RNA. The antibodies to HCV do not provide a certain measure infection because they do not identify all persons infected with the virus. (Braunwald, 15/E, p 1732)
What would be the Interpretation of Hepatitis D Superinfection?
HBsAg: POSitive + Anti-HDV: POSitive +
A 29-year-old man with a history of injection drug use is seen by an internist with complaints of fever, fatigue, nausea, loss of appetite, joint pain, and abdominal discomfort for the past few weeks. He reports that his urine is dark and his skin looks yellowish. On examination, he is jaundiced, with an enlarged and tender liver. Subsequent laboratory tests are positive for elevated liver enzymes and serum bilirubin. Serologic testing is positive for HBsAg and IgM anti-HBc. What is the most likely diagnosis?
Hepatitis B Etiology and Epidemiology: Hepatitis B (HB) is caused by hepatitis B virus (HBV). HBV is transmitted sexually, by blood and other bodily fluids, by injection drug use, and perinatally. Clinical Manifestations: Clinical outcome and symptoms of HBV infection range from mild and self-limited to severe and chronic. Most primary infections are subclinical. Acute hepatitis, characterized by fever, fatigue, anorexia, nausea, and pain-associated hepatomegaly, occurs in 25%-35% of infected individuals. Symptoms indicative of more liver involvement include elevated liver enzymes, jaundice, pale stools, and dark urine. Markers of HBV infection—HB surface antigen (HBsAg), HBe antigen, and HBV DNA—are detected in serum. Chronic hepatitis occurs in about 10% of HBV infections and is defined as the detection of HBsAg, HBV DNA, and HBeAg for 6 months or more. Patients with chronic HB are at risk for liver cirrhosis, liver failure, and hepatocellular carcinoma. Pathogenesis: HBV infects hepatocytes but does not cause direct cytopathology. Hepatocellular injury is due to immune attack by cytotoxic T cells. Individuals who fail to clear the virus from the body become virus carriers, and chronic hepatitis and cirrhosis result. Antibody to HBsAg is protective and cell-mediated immunity important in clearing infection. Laboratory Diagnosis: HBV infection may be suspected initially by clinical presentation in combination with abnormal biochemical tests (liver enzymes, bilirubin), which prompt serologic assays. IgM antibody to HB core antigen (HBcAg) is an indicator of acute infection. The presence of antibody to HBsAg is associated with immunity to HBV infection. HBV genome and a quantitative viral load are determined by PCR assay. Treatment and Prevention: There is no specific treatment for acute HB. Chronic HB is treated with pegylated interferon-alpha, tenofovir, or entecavir. Choice of antiviral agent may depend on whether the patient also has HIV infection and requires HAART. Timing and duration of treatment depends on viral load, liver enzyme abnormalities, and disease severity (eg, cirrhosis, liver failure). Active immunization against HBV is achieved with a recombinant HBsAg vaccine. Passive immunization with HBV immune globulin is given to neonates born to HBsAg (+) mothers and after needlestick exposures. Avoidance of high-risk behavior is an important preventive measure.
What antibody is an indicator of acute HBV infection?
IgM antibody to HB core antigen (HBcAg)
Is Hepatitis B core antigen detected in Blood?
Nope
What does the appearance of anti-HBe indicate?
The appearance of antibodies to the HBe antigen occurs shortly after the disappearance of HBeAg and indicates that the patient is recovering from HBV infection
True/false Any initial positive serological marker results for hepatitis B should be verified by repeated testing of the same specimen in duplicate, followed by confirmation with an additional assay, such as an HBsAg neutralization test or a molecular test that detects HBV DNA
True
indirect enzyme immunoassay
What is this?
Case: A 30-year old phlebotomist presented with fever, persistent fatigue, and joint pain. She reports that a needle in a plastic garbage bag nicked her finger about 2 months ago. Her physical examination was within normal limits. Laboratory Data: Her laboratory data revealed elevated serum ALT and total bilirubin levels. Additional data included positive HBsAg and positive IgM anti-HBc. Her IgM anti-HAV and anti-HCV tests were negative. Does this patient have a form of infectious hepatitis? If so, what type?
Yes this data is consistent with acute or chronic HBV infection. The positive IgM anti-HBc indicates a new or recent acute infection. Yes. Hepatitis B HBeAg test to see if seroconversion is happening. Also look for anti-HDV antibodies to make sure there is no co-infection.
Someone who is vaccinated with HBV has only __________________ in serum
anti-HBs
What can be detected in the "Core Window" of HBV?
negative HBsAg and anti-HBs positive IgM anti-HBc
What serum test results indicate No seroconversion?
no anti-HBe no anti-HBs "No aunties"
What indicates a chronic carrier?
no anti-HBe after 6 months
