A 30 years 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/d1) with SGOT/SGPT (AST/ALT) of 1230/900 IU/ml. The serological tests showed presence of HBs Ag IgM anti-HBc and HBeAg. The most likely diagnosis:

Ans. (b) Acute hepatitis B infection with high infectivity See the following table, Do not try to learn it, just try to understand Commonly Encountered Serologic Patterns of Hepatitis B Infection HBsAg Anti-HBc Anti-Hac HBeAg Anti-HBe Interpretation + - lgM + - Acute hepatitis B, high infectivity + - lgG + - Chronic active Hepatitis B, high infectivity + - lgG - + 1. Late acute or chronic hepatitis B, low infectivity 2. HBeAg-negative (precore mutant) hepatitis B + + + +/- +/- 1. HBsAg of one subtype and heterotypic anti-HBs (common) 2. Process of seroconversion from HBsAg to anti-HBs (rare) - - lgM +/- +/- Acute hepatitis B Anti-HBc "window" - - lgG - +/- Low-lenel hepatitis B carrier or hepatitis B in remote post - + lgG - +/- Recovery from hepatitis B - + - - - 1. lmmunization with HBsAg (after vaccination)2. Hepatitis B in the remote past3. False-positive