Match the following clinical and serological profiles of patients with viral hepatitis to their most accurate diagnostic phase or infection state.
- Patient presents with acute jaundice and severe transaminitis. Serology: HBsAg(+), Anti-HBc IgM(+), HBeAg(+), Anti-HDV IgM(+).Acute HBV and HDV coinfection
- Asymptomatic patient. Serology: HBsAg(+), Anti-HBc IgG(+), HBeAg(-), Anti-HBe(+). Labs: HBV DNA 600,000 IU/mL, ALT 250 U/L.HBeAg-negative chronic active hepatitis B (precore/basal core promoter mutant)
- Asymptomatic 25-year-old female. Serology: HBsAg(+), Anti-HBc IgG(+), HBeAg(+), Anti-HBe(-). Labs: HBV DNA > 20,000,000 IU/mL, ALT 28 U/L.Immune-tolerant phase of chronic hepatitis B
- Patient with known asymptomatic chronic liver disease presents with an acute flare of transaminases and jaundice. Serology: HBsAg(+), Anti-HBc IgG(+), Anti-HDV IgM(+).HDV superinfection in a chronic HBV carrier
Cevap
Properly distinguishing the phases of chronic Hepatitis B (immune-tolerant vs. active mutant) and the timeline of Hepatitis D infection (coinfection vs. superinfection) based on core antibody classes (IgM vs IgG) and HBeAg status.
Accurate interpretation of viral hepatitis panels requires stepwise analysis. First, chronicity is determined by the presence of Anti-HBc IgM (acute) versus Anti-HBc IgG (chronic). Second, the addition of acute HDV markers (Anti-HDV IgM) differentiates coinfection (acute HBV + acute HDV) from superinfection (chronic HBV + acute HDV). Finally, in chronic HBV, discordant findings between HBeAg negativity and high HBV DNA/ALT suggest a viral mutation, while high HBeAg and DNA with normal ALT characterize the immune-tolerant phase.
Adım Adım Çözüm
Anahtar Kavram
Interpretation of complex viral hepatitis serology panels