The clinical features of acute hepatitis B are similar to those of acute hepatitis A and the other hepatitides.
Direct demonstration of virus in serum samples is feasible by visualising the virus particles by electron microscopy, by detecting virus-associated DNA polymerase, and by assay of viral DNA and its amplification by various techniques. All these direct techniques are often impractical in the general diagnostic laboratory, and specific diagnosis must therefore rely on serological tests. Many serological tests, mainly based on ELISA and less commonly used radioimmunoassays, are available for markers of infection with HBV. HBsAg first appears during the late stages of the incubation period and persists during the acute phase, declining rapidly when antibody to the surface antigen (anti-HBs) becomes detectable. Antibody of the IgM class to the core antigen is found in the serum after the onset of clinical symptoms and slowly declines after recovery and is replaced by IgG anticore, which persists for many years. Hepatitis B e antigen appears during the acute phase of illness and anti-e is detectable with recovery. Molecular techniques are available for HBV DNA polymerase and HBV DNA.
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