Question
A 30-year-old previously healthy woman presented to Medicine OPD with malaise, low- grade fever, nausea, vomiting, aversion to food, mild itching since one month. Serum showed elevated levels of AST and ALT and presence of antiHBcIgM. (
- (a) What is the probable clinical diagnosis. ( 1 mark(s)
- (b) Which phase is the patient in. ( 1 mark(s)
- (c) What are the common etiological agents for a similar condition. ( 2 mark(s)
- (d) In the above case scenario, what are the other serological investigations required. (e) How does one get this infection. (f) What is the long-term concern in this infection. (g) How does one prevent this infection. Give details. 2 mark(s)
Answer
a) Probable clinical diagnosis: Acute Hepatitis B infection — malaise, low-grade fever, nausea, vomiting, anorexia, itching (pruritus, from cholestasis), raised AST/ALT, and positive IgM anti-HBc confirm acute HBV infection.
b) Phase: the patient is in the acute infection phase — IgM anti-HBc is the key marker distinguishing acute/recent infection from chronic infection (where IgG anti-HBc would predominate).
c) Common etiological agents for a similar (acute viral hepatitis) presentation: Hepatitis A virus (HAV), Hepatitis B virus (HBV — confirmed here), Hepatitis C virus (HCV), Hepatitis E virus (HEV).
d) Other serological investigations required:
- HBsAg — to confirm current infection and assess whether it may become chronic.
- HBeAg/anti-HBe — to assess viral replication/infectivity.
- HBV DNA (quantitative PCR) — direct marker of viral replication.
- Anti-HBs — to assess for developing immunity/recovery over time.
- Anti-HCV, IgM anti-HAV, HEV serology — to exclude co-infection/alternative causes given overlapping presentation.
- Liver function tests (repeated) — bilirubin, ALT/AST trend, prothrombin time (to monitor for fulminant progression).
e) Mode of acquisition: parenteral (blood/blood products, contaminated needles/injecting drug use, needle-stick injury, unsafe medical/dental procedures), sexual contact, or vertical (perinatal) transmission from an infected mother.
f) Long-term concern: progression to chronic HBV infection (if HBsAg persists beyond 6 months), which carries a significant long-term risk of cirrhosis and hepatocellular carcinoma.
g) Prevention — details:
- HBV vaccination — a highly effective recombinant HBsAg vaccine, given as a birth dose (within 24 hours, particularly important for preventing perinatal transmission) followed by the primary infant series; also recommended for high-risk groups (healthcare workers, dialysis patients, household contacts of carriers).
- Screening of blood/blood products before transfusion.
- Safe injection practices and standard precautions in healthcare settings.
- Safe sexual practices.
- Post-exposure prophylaxis — Hepatitis B Immunoglobulin (HBIG) plus vaccination for neonates born to HBsAg-positive mothers, and for high-risk needle-stick/mucosal exposures.
- Health education about modes of transmission and risk reduction.