Question

 

 

Talk the following

1) Differential Diagnosis/Explore the

Pathogenesis of Disease Options.

 

 

2)Additional history and Tests.

Review the Epidemiology Aspects of the disease

 

 

 

3) Presumptive Diagnosis/Identify

Causative Agent.

 

 

 

 

Answer 1

Hepatitis B

1. Differential Diagnosis Pathogenesis of Disease Options: The process of differentiating between two or more conditions that share similar signs or symptoms. A patient with suspected hepatitis B virus (HBV) infection, other viral hepatitides and etiologies that can lead to cirrhosis and liver failure must be taken into consideration.  In addition, because a major mode of transmission of this disease is sexual, also consider the possibility of infection with human immunodeficiency virus (HIV) or other sexually transmitted diseases.

HBV acts like a stealth virus early in infection, remaining undetected and spreading until the onset of the adaptive immune response several weeks later. The pathogenesis and clinical manifestations of hepatitis B are due to the interaction of the virus and the host immune system, which leads to liver injury and, potentially, cirrhosis and hepatocellular carcinoma. Patients can have either an acute symptomatic disease or an asymptomatic disease.

2. Additional history and Tests :  

The “Hepatitis B Panel” of Blood Tests: Blood test is done.  “Hepatitis B Panel” includes three parts. All three test results are needed to fully understand whether a person is infected or not.

1. HBsAg (Hepatitis B surface antigen) - A positive HBsAg test result means that the person is infected with hepatitis B. This test can detect the actual presence of the hepatitis B virus in blood. If a person tests “positive,” then further testing is needed to determine if this is a new “acute” infection or a “chronic” hepatitis B infection. A positive HBsAg test result means that you are infected and can spread the hepatitis B virus to others through your blood.
2. anti-HBs or HBsAb (Hepatitis B surface antibody) - A "positive" or "reactive" anti-HBs (or HBsAb) test result indicates that a person is protected against the hepatitis B virus. This protection can be the result of receiving the hepatitis B vaccine or successfully recovering from a past hepatitis B infection. This test is not routinely included in blood bank screenings. A positive anti-HBs (or HBsAb) test result means you are “immune” and protected against the hepatitis B virus and cannot be infected. You are not infected and cannot spread hepatitis B to others.
3. anti-HBc or HBcAb (Hepatitis B core antibody) - A "positive" or "reactive" anti-HBc (or HBcAb) test result indicates past or current hepatitis B infection. The core antibody does not provide any protection against the hepatitis B virus (unlike the surface antibody described above). It can be fully understood by the previous history of disease that you , might have.

At least 391 million people, or 5% of the world's population, had chronic HBV infection as of 2017.[While another 145 million cases of acute HBV infection occurred that year. Regional prevalences range from around 6% in Africa to 0.7% in the Americas. The primary method of transmission reflects the prevalence of chronic HBV infection in a given area. In low prevalence areas such as the continental United States and Western Europe, injection drug abuse and unprotected sex are the primary methods, although other factors may also be important. In moderate prevalence areas, which include Eastern Europe, Russia, and Japan, where 2–7% of the population is chronically infected, the disease is predominantly spread among children. In high-prevalence areas such as China and South East Asia, transmission during childbirth is most common, although, in other areas of high endemicity such as Africa, transmission during childhood is a significant factor.

3.

Presumptive Diagnosis/Identify

Causative Agent : begins with general ill-health, loss of appetite, nausea, vomiting, body aches, mild fever, and dark urine, and then progresses to development of jaundice . Transmission of hepatitis B virus results from exposure to infectious blood or body fluids containing blood. A comprehensive literature search through the main scientific databases was performed to retrieve guidelines, following which an online survey was developed and sent to HPs in six areas of health care, including public health, to verify whether patients are aware of these guidelines, to retrieve additional guidelines and to find out whether specific professional training is available.

All newly diagnosed chronic HBV patients should undergo a complete history, physical assessment, and laboratory assessment in an effort to assess the severity of liver disease and potential need for antiviral therapy . A liver ultrasound is recommended in all newly diagnosed chronic HBV patients to assess for unsuspected liver masses, splenomegaly, and a nodular liver suggestive of advanced fibrosis or portal hypertension, which would influence decisions regarding treatment and monitoring. Perinatally or early childhood-acquired chronic HBV infection has a long 'immune tolerant phase', when patients are young, and HBeAg seropositive with a high viral load but with no significant liver disease. Newer noninvasive modalities such as liver elastography may play a future role in assessing disease severity, but liver biopsy is currently recommended in cases of diagnostic uncertainty.