Paper II — 2020 February (Supplementary) (2010 Scheme) — Q1
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Paper II
2020 February (Supplementary) (2010 Scheme) · 40 marks · 120 min
Question
A 45 years old patient was admitted to the hospital with history of loss of appetite,
malaise and jaundice of one month duration. He also gave history of blood transfusion
in the past. On laboratory examination he was found to be positive for HBsAg.
What is the etiological diagnosis
What are the various clinical features
Discuss various routes of transmission of disease
Describe the laboratory diagnosis of the condition
What are the prophylactic measures of this condition (1+2+2+3+2)
Q110 marksEssays
Answer
Etiological diagnosis: Hepatitis B virus infection — loss of appetite, malaise, jaundice, prior blood transfusion (a known risk factor for parenteral transmission), and positive HBsAg confirm current HBV infection.
Clinical features: a prodromal phase with anorexia, malaise, nausea, and low-grade fever, followed by the icteric phase — jaundice, dark urine, pale stools, right upper quadrant discomfort, and tender hepatomegaly; many infections are subclinical/anicteric; a minority progress to fulminant hepatic failure (acute, severe); chronic infection (if HBsAg persists beyond 6 months) can progress silently over years to cirrhosis and hepatocellular carcinoma.
Routes of transmission:
Parenteral — blood/blood product transfusion (as in this patient), contaminated needles/injecting drug use, needle-stick injury, unsafe medical/dental procedures.
Sexual contact — an important route, given the virus’s presence in body fluids.
Vertical (perinatal) — mother-to-child transmission, particularly during delivery, a major transmission route in endemic regions and associated with a high risk of chronicity in the infected infant.
Laboratory diagnosis:
HBsAg — indicates current infection.
IgM anti-HBc — indicates recent/acute infection.
HBeAg — marker of active replication/high infectivity.
HBV DNA (quantitative PCR) — most direct marker of viral replication.
Anti-HBs and IgG anti-HBc — for assessing immunity/past infection status on follow-up.
Prophylactic measures:
HBV vaccination — a highly effective recombinant HBsAg vaccine, part of routine infant immunization schedules and recommended for high-risk groups (healthcare workers, dialysis patients).
Screening of blood/blood products before transfusion.
Safe injection practices and standard precautions in healthcare settings.
Post-exposure prophylaxis — Hepatitis B Immunoglobulin (HBIG) plus vaccination for high-risk exposures (e.g., needle-stick, neonates born to HBsAg-positive mothers).
