Question: A 21 year old female presents with acute, severe hepatitis, anorexia and jaundice. Hepatitis B is part of the differential diagnosis (she got a new tattoo from a back alley parlor two months prior). How can you make the diagnosis of acute HBV?
A. HBV DNA level
B. HBV surface antigen
C. HBV core antibody (IgM)
D. HBV envelope antigen and antibody
Answer: Acute hepatitis B infection is transmitted from blood to blood or through sexual secretions. This is a case where HBV should be entertained; the incubation period is typical. Although hepatitis C infection is also transmitted via unsanitary tattooing, it is usually associated with less severe hepatitis (ALT 300-400 range, rather than > 1000 as seen in HBV).
A HBV core antibody (IgM) is a great way to make the diagnosis of an acute, de novo HBV infection. The other answer choices may be positive, and therefore suggestive of an active HBV infection, but will not cinch a new infection.
Whether patients should be treated is unclear. Few studies have addressed the benefits of antiviral therapy during acute infection. Since the likelihood of fulminant hepatitis B is less than 1 percent, one can wait to see if it is spontaneously cleared. If there are signs of fulminant failure, treatment should be initiated and a transplant evaluation is appropriate.