Hepatitis serologic tests

The practicing clinician has a number of different tests available to aid in the evaluation of patients with suspected hepatitis C. These include measurement of alanine aminotransferase (ALT) levels, liver biopsy, serological tests (ELISA and recombinant immunoblot assay), and molecular methods for detection and quantitation of HCV RNA. 

TABLE 25-4 Interpretation of Serologic Tests in Hepatitis B Virus ... 

Hepatomegaly, jaundice, and altered liver function tests have been reported in accidental poisonings with DME An outbreak of toxic liver disease was associated with DME exposure at a fabric coating factory. Thirty-six of 58 workers had elevations of either aspartate aminotransferase or alanine aminotransferase. Serological tests excluded known infectious causes of hepatitis in all but two cases. After modification of work practices and removal of the most severely affected from exposure, improvement in liver enzyme abnormalities and symptoms occurred in most patients. Medical surveillance of the working population for 14 months revealed no further cases of toxic liver... 

In children and adults, signs of non-specific reactive hepatitis have also been observed. (42, 47) Acidophilic liver cell necrosis occasionally develops, depending on the type of red corpuscles. The endothelial cells are distended, the portal zones show inflammatory infiltration and granulomas or retothelial nodules are frequently found, (s. fig. 25.4) The pathogens can be demonstrated in the liver. Cirrhosis may develop, especially after the destruction of the lobular architecture as a sequela of extensive parenchymal necrosis. There are various serological tests available, including the Sabin-Feldmann... 

An 87-year-old man took cinnarizine 75 mg/day for tinnitus and developed jaundice 7 weeks later, with dark urine and pale stools (6). He had taken no other drugs. Bile duct obstruction was ruled out and serological tests for viral hepatitis were negative. A liver biopsy 6 weeks later showed distinct centrilobular cholestasis and a shght lymphocytic infiltrate. He recovered completely and the hver tests were normal after another 3 months without cinnarizine. Rechallenge was not performed. 

A 50-year-old man with history of chronic hepatitis B had transient rises in serum transaminases after two successive episodes of autologous stem cell transplantation, with spontaneous resolution at that time PCR for hepatitis B virus was negative (76). Later he was given thalidomide and after 5 months suddenly experienced dizziness and jaundice. The concentration of hepatitis B virus DNA was 1641 pg/ml and serological tests for other viruses were negative. Despite conventional supportive care, he died of septicemic shock caused by Klebsiella pneumonia. Other hepatotoxic agents were excluded. 

A 15-year-old girl presented with abdominal pain and diarrhoea for 3 days. She became jaundiced and a presumptive diagnosis of infective hepatitis was made, but serological tests were negative. She subsequently died of fulminant liver failure. At post mortem her liver copper concentration was found to be grossly increased. 

AST were significantly below those seen in acute viral hepatitis. In addition, the ratio of the absolute values for serum ALT and AST often differ in the two diseases, tending to be greater than 1 in acute viral hepatitis and less than 1 in chronic alcohol-induced cirrhosis. The reason for the difference in ratio of enzyme activities released is not understood, but a lower level of ALT in the serum may be attributable to an alcohol-induced deficiency of pyridoxal phosphate. In addition, serologic tests for viral hepatitis were nonreactive. Her serum folate, vitamin B12, and iron levels were also slightly suppressed, indicating impaired nutritional status. 

Serologic testing for viral hepatitis type B, C, and D were nonreactive, but fecal studies showed shedding of hepatitis virus type A. Tests for antibodies to antigens of the hepatitis A virus (anti-HAV) in the serum were positive for the immunoglobulin M type. 

Hepatitis B vaccination without the use of HBIG is highly effective in preventing HBV infection in household and sexual contacts of persons who have chronic HBV infection, and all such contacts should be vaccinated. Postvaccination serologic testing is indicated for sex partners of persons who have chronic hepatitis B infections and for infants bom to HBsAg-positive women. 

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