Viral hepatitis B: diagnostic difficulties

ABSTRACT

Hepatitis B is highly endemic in Pakistan with about 10% of the population being carrier for hepatitis B virus [HBV]. These carriers may develop jaundice or acute viral hepatitis like picture due to many other causes. If a test to detect hepatitis B surface antigen [HBsAg] is only performed to classify the type of hepatitis, the patient may get mislabelled. At the Armed Forces Institute of Pathology, Rawalpindi, a total of 1570 adult cases, clinically presenting with hepatitis, were studied between January 1991 and December 1993. Out of the 361 cases found positive of HBsAg by RPHA and ELISA method. There were 110 [110/361, 30.5%] cases which expressed positively for Anti-HBc IgM; an indication of recent infection in the immediate past. The rest 251 [251/361, 69.5%] patients were, most probably, the HBV carriers and their current ailment was not due HBV. To diagnose a case of acute hepatitis B, it is essential that both HBsAg and Anti-HBc IgM must be looked for in patient's