SEROLOGIC TESTING...VIRAL HEPATITIS

Interpreting the serologic tests are always challenging, especially
during the stress of exam taking...but also at the practice setting.

We'll show you an easy method of remembering and diagnosing both
acute and chronic Viral Hepatitis.....JUST MEMORIZE ALL THE CLUES!!!


CLUE No.1 As on the previous posting, remember:

Any positive IgM test equals CURRENT illness. HINT: "M" "M"omentary
Any positive IgG test equals RESOLVED illness. HINT: "G" "G"one

Just knowing this simple clue.....you've won half the battle!!!

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CLUE No.2 Always divide illess into ACUTE and CHRONIC.


CLUE No.3 ALL Viral Hepatitis has an ACUTE FORM:
HAV, HBV, HCV, HDV and HEV. (a,b,c,d,e) can it be more simple.


CLUE No 4. ONLY THREE types of Hepatitis has CHRONIC FORM:
HBV, HCV and HDV.


By now, you had won three quarters of the battle....the rest is easy.
Let's put it all together by REMEMBERING ALL THE ABOVE INFORMATION.

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ACUTE HEPATITIS SEROLOLGY (IgM)


HEPATITIS A (HAV)........+IgM Anti-HAV

HEPATITIS B (HBV)........+IgM Anti-HBc
This is the BEST and MOST SENSITIVE MARKER!!!!

HINT: Acute HBV infection causes
elevation of ALL elements, thus + results:

"c"-Core: +IgM Anti-HBc (as above).
"e"-Envelope: +HBeAg
"s"-Surface: +HBsAg

DON'T FORGET:

On the exam and in clinical practice, the
BEST TEST is always +IgM Anti-HBc !!!!!


HEPATITIS C (HCV).......+HCV RNA (by PCR)...The BEST TEST!!!
+Anti-HCV

HEPATITIS D (HDV)........+Anti-HDV (Remember, there must be a co-
-existing HBV infection).


HEPATITIS E (HEV).......+ IgM Anti-HEV

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CHRONIC HEPATITIS SEROLOGY (IgG)


HEPATITIS B (HBV)......+IgG Anti-HBc

HEPATITIS C (HCV).......+Anti HCV
+HVC-RNA

HEPATITIS D (HDV)......+IgG Anti-HDV (This infection can never outlast HBV)


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RECOVERED/RESOLVED PHASES OF HEPATITIS (IgG)


HEPATITIS A (HAV).......+IgG Anti-HAV (Confers Immunity/Prior Infection)

HEPATITIS B (HBV)........+ Anti-HBs (Confers Immunity/Prior Infection)

HEPATITIS C (HCV)........-Anti-HCV-RNA (by PCR) (Resolved Viral Load)
+Anti-HCV (Remains + for life)

HEPATITIS D (HDV)........+IgG Anti-HDV

HEPATITIS E (HEV)........+IgG Anti-HEV


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Thanks for your time and attention.....hope it was simple, fun and not hard at all!!!

HEPATITIS FACTOIDS.....Made Simple

We'll review some important generalizations about "HEPATITIS"
while keeping it simple, easy to recall....and fun to memorize.


HINT: the CAPITALIZED words, are the KEY features to remember!!!





IgM ----- implies a CURRENT/ACTIVE process.
IgG------ implies a RESOLVED process. HINT: "G" Gone!!!



Hepatitis A Virus (HAV).....does NOT have a chronic form.

Hepatitis E Virus (HEV).....also does NOT have a chronic form. With PREGNANCY it has
> 20% mortality, in endemic areas, esp. Asia.

Hepatitis B Virus (HBV)....99% patients recover from ACUTE form of infection, without
treatment. Symptoms are usually SERUM SICKNESS-like
with URTICARIA, ARTHRALGIA, ANGIOEDEMA, prior to
jaundice.

Hepatitis C Virus (HCV)....acute form is rarely symptomatic. Thus, most patients are
diagnosed incidentally. GENOTYPE 1 is most common, @ 75%
and also has the WORST PROGNOSIS in USA. No vaccine
available, yet.

Autoimmune Hepatitis.....is non infective, but can cause FALSE positive HCV test.
NO PRURITUS involved. If patient c/o itching, look for
an alternate diagnosis.

Drug Induced Hepatitis....generally causes an ELEVATED LDH and normal hepatitis
profile. Moderate-severe elevated LFT's. Accounts for about
40% cases of hepatitis in USA.


Hepatitis D Virus (HDV)....requires CO-INFECTION with Hepatitis B (HBV).
Thus, cannot diagnose HDV infection without HBV.


Ischemic Hepatitis...........Most common cause is POOR CARDIAC OUTPUT, with
systemic hypotension/hypoxia. AST/ALT elevation in the
THOUSANDS within hours of HYPOPERFUSION injury.


Alcoholic Hepatitis..........Has 10-40% mortality. Patients are usually malnourished
and present with FEVER, jaundice, RUQ pain, modest AST/ALT
elevations (2:1/3:1 ratios) and ELEVATED IgA levels!!!


Glucocorticoids.................are CONTRAINDICATED in any form acute VIRAL Hepatitis.


Chronic Hepatitis............. requires the illness to be present for > SIX MONTHS by definition.



Thanks for you time. Next posting we'll review interpretation of viral hepatitis
laboratory tests......made simple.

Types of Pneumonia....DETECTIVE CLUES...

Knowing the CLUES BY HISTORY, will make all the difference on the exam and in
clinical practice.


1. MYCOPLASMA PNEUMONIA....Seen generally in YOUNG adults. Common in the fall
and spring. Frequently associated with a RASH and BULLOUS MYRINGITIS.



2. CHLAMYDIA PNEUMONIA...Also common to YOUNG adults. E.g. college dorm students,
military recruits/barracks and frequently follows a prolonged SORE THROAT/URI.
The organism responsible is Chlamydia Trachomatis.



3. PSITTACOSIS PNEUMONIA...Occurs in patients who are in contact with BIRDS.
(pigeons/parakeets/parrots/chickens.) Either through occupation or as pets.
Causative organism is Chlamydia Psittaci.



4. STREPTOCOCCUS PNEUMONIA...Is the most common of the CAP's. Usually very
ACUTE/ABRUPT onset, more common in patients with underlying COPD.



5. KLEBSIELLA PNEUMONIA....Especially common in ALCOHOLICS and in patients
with Diabetes Mellitus/Nursing Home populations.



6. LEGIONELLA PNEUMONIA....Associated with WATER VAPORS. E.g. humidifiers,
air conditions, hot tubs, cooling towers and ventilation systems. Clinically, frequently
associated with CONFUSION/DIARRHEA/HYPONATREMIA and pleural effusions.



7. STAPHYLOCOCCUS AUREUS PNEUMONIA....Frequently follows INFLUENZA.
Tends to leave CAVITARY lesions on the CXR.



8. HAEMOPHILUS INFLUENZAE PNEUMONIA....Also, frequently follows a bout of
upper respiratory infection (URI) and especially common in pts. with COPD.



Thanks for your time....remember the clues!

Clinical gems....Infectious Diseases

We'll continue with the "exciting" material from the field of Infectious Diseases.



Q: What are the common communicable diseases causes by Deer Ticks?


A: Lymes Disease / Ehrlichiosis / RMSF(Rocky Mountain Spotted Fever) / Q Fever
Babesiosis and Tularemia.
HINT: Each time you see a patient with a "tick bite" consider all of the above
not just Lyme's, which is the most notable and common.




Q: What disorder is the most common RISK FACTOR for native valve endocarditis?


A: Mitral Valve Prolapse (MVP). Remember, NATIVE valve.
HINT: Risk factors for prosthetic valve endocarditis are usually NOSOCOMIAL
infections.




Q: Which type of organism is most serious occuring from a DOG BITE?

A: CAPNOCYTOPHAGA CANIMORSUS infection. This can be lethal in patients who are
immunocompromised, such as Splenectomized, HIV, Chemotherapy patients, etc.
Sepsis treatment requires: 2 wks. of IV PCN-G antibiotic.





Q: What is the BEST lab test to determine need for continued antibiotic treatment
in a patient with Osteomyelitis?


A: C-REATIVE PROTEIN. Is the single BEST lab test, to determine the "success"
of the antibiotic regimen....not he Sed Rate.





Q: What is the HALLMARK physical symptom of Whooping Cough.

A: PAROXYSMAL cough! Repetitive BURSTS of 5-10 episodes of cough. frequently
followed by post-tussive vomiting. The other symptom is the audible "whoop".
(The organism responsible is Bordatella Pertussis. A Gram negative bacilli).




Q: What is the treatment of a PREGNANT patient with Syphilis?

A: Same as the non-pregnant. PCN-G is the ONLY treatment, whether pregnant or not.
HINT: If patient is allergic to PCN....must DESENSITIZE and still use PCN. This applies
to all patients!!!





We'll continue next week. Study hard.