Differential Diagnosis of Viral Hepatitis, October 3, 1987

Differential Diagnosis of Viral Hepatitis, October 3, 1987

For HBsAg-positive patients, if anti-HBc IgM is positive, it is usually acute hepatitis B; if negative, it is chronic hepatitis B. A diagnosis can be made when HBsAg is positive, but even if HBsAg is negative and anti-HBc is positive, a diagnosis should still be made. Most cases of initial infection with acute hepatitis B are transient, and very few are caused by conversion from viral carriers. Such cases can be diagnosed as newly infected individuals, with detailed medical history taking being the primary basis for judgment. The serological profile of acute hepatitis B is shown in the figure on the right (excluding the e-antibody value before it appears). As the figure shows, the hallmark of acute hepatitis B onset is: HBs antigen and anti-HBc IgM rising simultaneously between months 0 and 4, with e-antigen positive between months 0 and 2, followed by e-antibody positivity after month 2; transient infections will inevitably resolve.