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  #1  
Old 09-01-2012
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Virus Hepatitis B Serology Question

A 61-year-old man with mild jaundice is seen on a follow-up visit by his physician for evaluation of possible hepatitis B infection. The results of his hepatitis B panel are:
HepBsAg positive
anti-HepBsAb negative
anti-HepBcAb positive
Based on the hepatitis B panel, the patient most likely has

A. Acute hepatitis B
B. Been effectively vaccinated with hepatitis B vaccine
C. Chronic infection with hepatitis B
D. Had a previous infection with hepatitis B virus
E. Never been infected with hepatitis B

**i think question sucks because they did not mention type of Core antibody ? IgM or IgG...ur thought ?
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  #2  
Old 09-01-2012
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A. acute hep b
the patient is in the window period where he might be labled as not having hep b but since his anti-hepBc is positive this makes it acute hep b in the window period. this is the best way to detect hep b
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Old 09-01-2012
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Quote:
Originally Posted by firstaid150 View Post
A. acute hep b
the patient is in the window period where he might be labled as not having hep b but since his anti-hepBc is positive this makes it acute hep b in the window period. this is the best way to detect hep b
he is not in window period because his hepBsAg is also positive !what say ?
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Old 09-01-2012
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could be acute hep B or chronic .... according to the type of anti HepB core Ab
IgM or IgG
.
as he said the pt is coming for follow up I 'd go for chronic hep B
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Old 09-01-2012
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Default Might be C

Both acute & chronic Heptitis have similar serologic pattern apart from the type HBc Ab wether M for acute infection & G for chronic. As its not mentioned, i would go with the hx of F/U visit
So the answer might be C
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Old 09-01-2012
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would go for C...

agree with anders and the presentation is not an acute one
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Old 09-01-2012
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Answer C .Dont know what to choose b/n acute and chronic ,taking a guess.
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Old 09-02-2012
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I would go for C
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Old 09-02-2012
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C. Chronic infection with hepatitis B

Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame.
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Old 09-02-2012
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Answer I would say A Acute hepatitis.

Anti HbCAg is suggetive of acute hepatitis..

In chronic hepatits both AntiHbcAg and AntiHbSAg will be positive..
Here AniHbsAg is -ve So not Chronic Hepatitis B

Hepatitis B Serology Question-hepatitis-serology-timeline.jpg
click image to enlarge
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Old 09-02-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
Answer I would say A Acute hepatitis.

Anti HbCAg is suggetive of acute hepatitis..

In chronic hepatits both AntiHbcAg and AntiHbSAg will be positive..
Here AniHbsAg is -ve So not Chronic Hepatitis B

Attachment 2797
click image to enlarge
Anti-HbsAg indicates recovery or immunity to Hepatitis B.
Surface Antibody appearance means Resolution of infection or Immunized state (but of course surface antigen should be negative)

In chronic hepatitis IgG AntiHbcAg is positive but AntiHbsAg is negative
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Old 09-03-2012
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ans given is A. but again, they could have mentioned AntiCIgM to make q clear. isnt ?
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Old 09-04-2012
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Quote:
Originally Posted by tyagee View Post
ans given is A. but again, they could have mentioned AntiCIgM to make q clear. isnt ?
I don't know why the answer is A but you are right since IgM anti-HBc status is needed to differentiate between the two.

According to CDC:

Acutely infected:

Quote:
HBsAg positive
anti-HBc positive
IgM anti-HBc positive
anti-HBs negative
Chronically infected:

Quote:
HBsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBs negative
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Old 10-05-2012
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Quote:
Originally Posted by firstaid150 View Post
A. acute hep b
the patient is in the window period where he might be labled as not having hep b but since his anti-hepBc is positive this makes it acute hep b in the window period. this is the best way to detect hep b
Correct me if I'm wrong, but doesn't the "window period" refer to that point when the HBs antigens and antibodies are in equal amounts and therefore cancel each other out in the serum? The HBsAg and anti-HBsAg should be both negative during the window period.
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Old 10-06-2012
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During the window period ONLY anti HBc IgM is positive, both Anti HBs and AgHBs are negative because they cancel out or are actively bound to each other.

this question is wrong because we cannot know for sure if it is acute or chronic -_-
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Old 10-06-2012
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I just went with acute Hep B because its more common than chronic hep B. Obviously it could be either one, but its more likely to be an acute case considering very few patients actually go on to chronic disease.
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Old 10-07-2012
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Default acute hepatitis b

guys ans is acute hepatitis
as far as i understand...the only thing which confirm hep b is...fr hw long HBsAg is present...if its more than 6 mnths ..its chronic
they didn mention time period so consider it acute...bcz to say it chronic u must have evidence of hbsag positive fr 6 mnths
secondly acute hep b is far more common than chronic...only 5 percent f hep b become chronic
fischer also mentioned something like this in his im video
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Old 10-07-2012
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Yup, I also answered acute just by epidemiology and natural disease course.
Only 15-20 % of Hepatitis B cases will go into chronicity (this, however, is not true in neonates, as 90% will go into chronicity) so without timeframe or exact antibody; acute is more likely
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