deception by hepatitis B surface antigenaemia negativity in acute viral hepatitis cases

ABSTRACT

It is because of the limited availability of viral hepatitis serology services in Pakistan that Hepatitis B Virus [HBV] surface antigen [HBsAg] detection is being used widely as the sole diagnostic marker for HBV in the screening of blood donors and for the diagnosis of acute hepatitis-B cases. As a consequence, a negative hepatitis B surface antigenaemia could possibly lead to false diagnosis in cases of acute viral hepatitis [AVH] on the part of attending laboratory staff and treating clinician. This possibility necessitates added use of other relevant viral hepatitis markers which could help in establishing a correct diagnosis in acute viral hepatitis B cases. From December 1989 - November 1993, a total number of 746 cases of AVH, initially diagnosed on the basis of their clinical picture and liver function profiles, and with a negative HBsAg status, were further tested for anti HBc-IgM in their sera by ELISA technique. In this series there were 8 cases AVH which were positive for anti-HBc IgM, thereby confirming that these 8 cases had a recent HBV infection. In conclusion, a negative HBs-antigenaemia in isolation must be interpreted with caution. In cases, where a strong clinical suspicion of acute HBV infection exists, the estimation of anti HBc IgM must be carried out, particularly in cases of fulminant viral hepatitis