A 23 year-old male security guard working in a small department store was stabbed with a needle on a syringe of an intravenous drug addict he was arresting for shoplifting. Six weeks later he developed general malaise, with nausea and vomiting. He lost his appetite and began to lose weight. When he noticed darkening of the urine and a yellowish color to his sclerae, he came to your office. The patient denied a history of hepatitis or liver disease. He denied drug abuse, and had no history of blood transfusions, surgery or exposure to jaundiced individuals. He never traveled outside the US.

Physical examination revealed a well developed young man in no acute distress. Positive physical findings included: jaundice and a firm, enlarged and tender liver. He had no adenopathy.

Questions:

1. The security guard developed hepatitis six weeks after the incident involving the hypodermic syringe

(a) given the length of time that has elapsed, is it likely that the incident has anything to do with the disease?

(b) if the incident had occurred 48 hrs prior to onset of symptoms, would it be likely it had anything to do with the disease?

2. If one were to acquire hepatitis via a needle stick from the syringe of an intravenous drug addict, what kind(s) of hepatitis would be most likely?

3. Laboratory tests showed:

HAV Ab(total) - Positive

HAV Ab(IgM) - Positive

HBsAg - Negative

total anti-HBcAg - Negative

anti-HBsAg - Positive

HCVAb(total) - Negative

(a). How do you interpret the result of the HAV tests?

(b). How do you intepret the result of the HBV tests?

(c). Is the security guard likely to be infectious for viral hepatitis?

(d). Is he at risk for developing chronic viral hepatitis?

(e). Should he be tested for HDV?

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