Review Question - QID 102718

The patient presents with cirrhosis (jaundice and abdominal pain) in the setting of serology which supports a diagnosis of a chronic hepatitis B infection.

Hepatitis can present acutely with vague systemic symptoms (such as fatigue, malaise, and weight loss) or signs of liver dysfunction including jaundice, abdominal distension/ascites, and hepatic encephalopathy. The diagnosis of cirrhosis can be supported with abnormal liver function tests including the PT/PTT, serum albumin, and fractionated bilirubin levels. A chronic hepatitis B infection presents with the following serology and rationale for interpretation.

- Hepatitis B surface antigen: Positive - reflects that the virus is present
- Hepatitis B surface IgG: Negative - suggests that a final immune response protective against hepatitis B has not occurred
- Hepatitis B core antigen: Positive - suggests an active hepatitis B infection
- Hepatitis B core IgG: Positive - suggests an active immune response against the active infection (but is chronic because it is IgG not IgM)
- Hepatitis B E antigen: Positive - this suggests a high infectivity component of the hepatitis infection
- Hepatitis B E IgG: Negative - this suggests that an immune response has not been formed against the highly infective form

Incorrect Answers:
Answer 1: Acute hepatitis B infection presents with the following serology.
- Hepatitis B surface antigen: Positive - reflects an active infection
- Hepatitis B surface IgG: Negative - reflects that the final immune response has not occurred/cleared the infection
- Hepatitis B core antigen: Positive - reflects an active infection
- Hepatitis B core IgM: Positive - reflects an initial immune response (note, it is IgM not IgG)

Answer 3: Hepatitis B vaccination presents with the following serology.
- Hepatitis B surface antigen: Negative - suggests that active infection is not present
- Hepatitis B surface IgG: Positive - reflects the finalized immune response to the hepatitis antigen
- Hepatitis B core antigen: Negative - reflects no active infection
- Hepatitis B core IgG: Negative - reflects that a primary infection never occurred thus there was no IgG response to the core antigen

Answer 4: No hepatitis B vaccination or infection would present with all serological markers (including hepatitis B antigens and antibodies) as negative.

Answer 5: Resolved hepatitis B infection presents with the following serology.
- Hepatitis B surface antigen: Negative - reflects infection has been cleared
- Hepatitis B surface IgG: Positive - reflects appropriate immune response to infection/vaccination
- Hepatitis B core antigen: Negative - suggest virus has been cleared
- Hepatitis B core IgG: Positive - suggests appropriate immune response to previous infection (not seen with vaccination)

Bullet Summary:
A chronic hepatitis infection presents with a positive hepatitis B surface antigen, core antigen, core IgG antibody, and E antigen with a negative IgG to surface and E antigen.