Question

A thirty-year man presented with nausea, fever and jaundice of 5-days duration. The biochemical tests revealed a bilirubin of 6.7 mg/dl (conjugated 5.0 mg/dl) with SGOT/SGPT (AST/ALT) of 123/900 IU/ml. The serological tests showed presence of HBsAg, IgM anti-HBc and HBeAg. The most likely diagnosis is:

• A. Chronic hepatitis B infection with high infectivity
• B. Acute hepatitis B infection with high infectivity
• C. Chronic hepatitis B infection with low infectivity
• D. Acute hepatitis B infection with low infectivity

Hint:

IgM anti-HBc marks a recent infection, and HBeAg marks high viral replication and infectivity.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
A young man has fever, nausea and jaundice for 5 days, with a raised conjugated bilirubin and very high transaminases (AST/ALT 123/900), and serology positive for HBsAg, IgM anti-HBc and HBeAg. We need to decide the stage of hepatitis B infection and its infectivity.

Step 2: Key Concept:
IgM anti-HBc is the antibody the body makes first against the hepatitis B core antigen, and it stays positive only during a recent or acute infection, typically for a few months. IgG anti-HBc replaces it once the infection turns chronic or resolves. HBeAg is a marker of active viral replication, and a person who is HBeAg positive is shedding a large amount of virus and is highly infectious.

Step 3: Detailed Explanation:
The short history of 5 days along with a very high ALT of 900 IU/ml points to an acute, fresh hepatic injury rather than the milder, fluctuating enzyme rise typically seen in chronic hepatitis. The presence of IgM anti-HBc confirms this is a recent, acute infection, since IgM anti-HBc would not still be positive in someone with longstanding chronic hepatitis B. The positive HBeAg tells us the virus is actively replicating, which makes this patient highly infectious to others. Putting the acute-infection marker (IgM anti-HBc) together with the high-infectivity marker (HBeAg) gives acute hepatitis B infection with high infectivity.

Step 4: Final Answer:
The correct diagnosis is acute hepatitis B infection with high infectivity, option (2).