A 48 year old waitress presents to a physician with malaise, loss of appetite, nausea, moderate fever, and jaundice.Laboratory tests indicate a marked increase in serum transaminases. Serology for hepatitis viruses is performed and indicates positive results for the presence of HBsAg, HBc IgM antibody, and HCV antibody. Antibody tests for HBsAb and HAV are negative. The results indicate:
The presence of hepatitis B surface antigen (HBsAg) along with hepatitis B core IgM antibody (HBc IgM Ab), and the absence of hepatitis B surface antibody (HBsAb) indicates the presence of the early stages of an acute infection with Hepatitis B. The presence of antibody to Hepatitis C (HCV) only indicates exposure, but not a specific time of exposure; however, 85% of patients who are infected with HCV develop chronic infections, indicating that this patient has an 85% chance of having a dual infection with HBV and HCV. The acute or chronic HCV infection can be confirmed by PCR. A dual infection of HBV and HAV is not plausible since the IgM anti-HAV serology is negative. Hepatitis A does not cause chronic disease. Chronic HBV infection is unlikely because the patient has HBc IgM Ab, which is characteristic of an acute infection, rather than a chronic infection. Ref: Ray C.G., Ryan K.J. (2010). Chapter 13. Hepatitis Viruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
A dual infection of HBV and HAV
Chronic hepatitis A infection
Chronic hepatitis B infection
The presence of an acute HBV infection.