Go to Homepage

Go to Gettings Family

Case 2 Answer

Gerry arrives at the clinic for the tests. He complains of malaise, nausea, and fullness in upper right quadrant, low-grade fever, and distaste for his morning coffee. Palpation reveals hepatomegaly. Upon further examination you notice Gerry has icterus and jaundice. Liver enzyme levels were elevated. See Gerry's History for HepB vaccination. The following tests were ordered and results recorded.

Which of the following diagnoses is most appropriate for Gerry’s present condition?

1. HIV negative and is immune to HBV infection- HIV status correct; ELISA's were positive but Western blot was negative; He is not immune to HBV; no Anti-HBs
2. HIV negative and has an acute HBV infection- two positive ELISAs however Western blot the confirmatory test is negative; Acute HBV- positive for HBsAg and IgM for HBc*
3. HIV negative and has a chronic HBV infection- HIV status correct; ELISA's were positive but Western blot was negative; He does not have chronic HBV; need two HBsAg positive tests with at least 6 months between tests
4. HIV positive and is immune to HBV infection- HIV status wrong; ELISA's were positive but Western blot was negative; He is not immune to HBV; no Anti-HBs
5. HIV positive and has an acute HBV infection- HIV status wrong; ELISA's were positive but Western blot was negative; He is does have an acute HBV infection; Even though he was vaccinated two times; the first time he did not produce antibodies to HBs and the second time NO serologies were performed to see if he was producing Anti-HBs.
6. HIV positive and has a chronic HBV infection- HIV status wrong; ELISA's were positive but Western blot was negative; He does not have chronic HBV; need two HBsAg positive tests with at least 6 months between tests

Go back to Case 2

To refresh your neurological network for Hepatitis B Virus Serologies. Usually, three to four tests are ordered; HBsAg (HBV surface antigen test), the Anti-HBs or Anti-HBsAg test (look for antibodies to the HBV surface antigen), and either total Anti-HBc (look for IgG and IgM for HBV core antigen) OR Anti-HBc IgG and Anti-HBc IgM.

Go to Homepage

© 1996-2013 Neal Chamberlain. All rights reserved.  
Site Last Revised 11/12/13
Neal Chamberlain, PhD. A. T. Still University of Health Sciences/Kirksville College of Osteopathic Medicine.

Take Care and Think Microbiologically!