Tassawar Hussain, Saloom Uz Zaman Ahmed.
Acute Hepatitis B - Serological confirmation.
Pak Armed Forces Med J Jan ;48(2):102-5.

Hepatitis B virus (HBV) is highly endemic in Pakistan. It may cause a wide variety of acute or chronic hepatic -and extrahepatic diseases, as well as chronic carrier state. A study was carried out to ascertain the incidence of acute hepatitis B in adult patients presenting with jaundice, who were positive for HBsAg, by further testing for IgM anti HBc. Presence of IgM anti-HBc antibodies was taken as an evidence of acute hepatitis B. A total of 4315 adults including 3739 (86%) male and 576 (14%) female, clinically presenting with hepatitis , were admitted to Military Hospital Rawalpindi between June 1995 and December 1996. Blood samples were tested for liver function tests and HBsAg by RPHA or ELISA. HBsAg was positive in 504 (11.68%) cases including 457 (86.70%) males and 67 (13.30%) females, and while 3811 (88.32%). A group of randomly selected 100 cases of acute hepatitis, (mean age 36.28 + 12.90 years), positive for HBsAg , (including 78 males and 22 females) was kept in hospital till clinical and biochemical recovery. Two hundred healthy blood donors, negative for HBsAg (ELISA), were taken as control. History of blood transfusion, inoculation/needle prick, past history of jaundice, extramarital sexual contact, drug abuse and any past surgical procedure was obtained from both study groups. Out of the 100 cases tested for IgM anti HBc, 68 reacted positive for it, an indication of recent HBV infection. The rest of 32 who reacted negative, Were most probably the HBV carriers and their current illness was not due to primary HBV infection. The incidence of acute hepatitis B in cases presenting with jaundice, who were positive both for HBsAg and IgM anti HBc comes to be 7.8%. On thorough interview 27% had a history of needle prick as compared to 5.5% in controls (P value 0.0105), 8% had history of blood transfusion as compared to 5.5% in control (P value .0005), while surgery had been done in 9% cases as compared to 6% in control (P value .3425). Clinically it was not always possible to differentiate between IgM anti HBc positive and negative cases, however the disease was clinically more severe in positive cases. 93% cases recovered clinically and biochemically within 65 to 90 days. 2% cases developed fulminent hepatitis leading to coma and death, and 5% show evidence of chronicity at the end of 6 months of observation and follow up. For precise viral diagnosis of acute HBV infection the patient should be, preferably, tested both for HBsAg and IgM anti HBc. Follow up of cases of HBV infection is important.

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