Hepatocyte hepatitis B surface antigen. Diagnostic evaluation of patients with clinically acute hepatitis B surface antigen-positive hepatitis.

Patients who were diagnosed as having acute hepatitis B by conventional criteria were reevaluated by a correlative study of tissue hepatitis B surface antigen (HBsAg) and serologic tests for anti-hepatitis A virus, IgM, and/or anti-hepatitis B core antigen (anti-HBc) IgM. The results demonstrated that the diagnosis of acute hepatitis B in an endemic area was complicated by superinfection or reactivation of unrecognized hepatitis B carriers or chronic hepatitis B patients simulating acute hepatitis clinically. Anti-HBc IgM failed to discriminate newly infected acute hepatitis B from reactivation of chronic hepatitis B liver disease, especially when the enzyme-linked immunoassay index value was low. Our data suggest that a combination of different tissue HBsAg expression patterns usually indicate the presence of underlying chronic liver disease, while the tissue HBsAg was practically all negative in newly infected cases. Therefore, the study for tissue HBsAg expression by the immunoperoxidase method is an invaluable aid in identifying true acute hepatitis B in patients in an endemic area.