董艾倫，醫學博士； 王靜，醫學博士 / 2024/ 02/20 / 藥物與疾病 / Medscape / 案例挑戰
病例挑戰系列包括難以診斷的病症，其中一些大多數臨床醫生並不經常遇到，但準確識別仍然很重要。 使用以下患者場景和相應問題來測試您的診斷和治療技能。 如果您有一個案例想要建議用於未來的案例挑戰，請與我們聯絡。
背景
一名 29 歲女性有 2 週的疲勞、噁心和肌肉疼痛病史。一週前，她在家中自我檢測驗孕結果呈陽性，她將自己的症狀歸因於懷孕。這是她第一次懷孕。她的月經規律，並且對末次月經 (LMP) 的日期充滿信心。根據她的末次月經，她就診時已懷孕 7 週 1 天。
她報告說，過去幾週她的食慾有所下降，但沒有報告任何其他症狀，包括發燒、發冷、腹痛、胸痛、氣短、頭痛、便秘、腹瀉或泌尿症狀。患者稱這是意外懷孕。她嫁給了一位長期的男性伴侶；然而，她表示她的婚姻是開放式的。她報告說在過去的一年裡與兩名男性和三名女性發生過性關係。在過去的一個月裡，她與一名新的男性伴侶和新的女性伴侶發生性行為。她報告說，她和她的伴侶很少使用屏障式避孕方法。
她的病史並無異常，過去也沒有接受過任何手術。她沒有服用任何藥物。她報告說她童年時對青黴素過敏。她之前接受過衣原體和淋病的治療，但她並沒有報告靜脈注射毒品史。
在五個月前的年度訪問中，她沒有任何抱怨。常規實驗室結果在正常範圍內，且該次就診時披衣菌、淋病、愛滋病毒感染、梅毒、B型肝炎和C型肝炎的性傳播感染篩檢之檢驗結果為陰性。
身體檢查和檢查和後處理
經檢查，患者神智清醒、定向力強，沒有嚴重痛苦。她的體溫為 99.1 °F (37.28 °C)，脈搏為 95 次/分鐘，血壓為 102/60 mm Hg，呼吸頻率為 16 次/分鐘，室內空氣中其氧飽和度為 99%。未發現鞏膜黃疸、黃疸或淋巴結腫大。聽診心臟和肺部清晰。腹部柔軟，觸診無壓痛，無肝脾腫大。她有輕微的足部水腫，但其餘檢查基本上沒有異常。
常規實驗室研究和產前小組揭示了這些數值：
•血型：A+
•抗體篩檢：陰性
•白血球計數：6.8×109/L（參考範圍4.5-11.0×109/L）
•血紅素濃度：12.1 g/dL（參考範圍，11.6-15 g/dL）
•血球容積比：36.7%（參考範圍，35.5%-44.9%）
•血小板計數：230 × 109/L（參考範圍，150-400 × 109/L）
•肌酸酐濃度：0.41 mg/dL（參考範圍，0.5-1.1 mg/dL）
•血糖值（隨機）：92 mg/dL（空腹參考範圍，70-99 mg/dL）
•丙胺酸轉氨酶濃度：221 U/L（參考範圍，7-56 U/L）
•天門冬胺酸轉氨酶水準：60 U/L（參考範圍，8-33 U/L）
•德國麻疹免疫球蛋白 G 濃度：84.7 IU/mL（參考範圍，> 9 IU/mL）
•尿液培養：20-50,000 菌落形成單位/mL，無主要微生物
額外的測試結果正在等待中。
僅根據這些發現，哪一個是最可能的診斷？
妊娠急性脂肪肝
子癇前症
正常懷孕
急性C型肝炎
慢性C型肝炎
僅根據這些發現，哪一個是最可能的診斷？
您的同行選擇了：
妊娠急性脂肪肝20%
子癇前症 3%
正常妊娠16%
急性C型肝炎 51%
慢性C型肝炎 10%
討論
C型肝炎抗體檢測和C型肝炎RNA聚合酶鏈反應（PCR）檢測結果呈現反應性。 HIV、淋病、披衣菌和B型肝炎的檢測結果均為陰性，快速血漿反應素檢測結果也是陰性。因此，該患者很可能患有急性C型肝炎病毒（HCV）感染。事實上，她在 5 個月前接受了篩檢，檢測結果呈現陰性，這顯示這可能是一種新的急性C肝病毒感染。在沒有事先檢測結果的情況下，區分急性 HCV 感染和慢性感染之惡化更是具挑戰性。
多達 80% 的急性C型肝炎患者沒有任何症狀。在有症狀的人中，大多數表現為非特異性症狀，如發燒、疲勞、食慾下降、噁心、嘔吐或腹痛。有些患者有深色尿液、蒼白糞便或關節疼痛。儘管黃疸通常與肝炎有關，只有約 5% 的C型肝炎患者出現黃疸。圖 1 顯示了另一位患者的 HCV 相關黃疸。
C型肝炎的非特異性症狀很容易與其他疾病的症狀混淆，例如早期懷孕症狀，就像本例患者一樣。儘管她的症狀可能歸因於懷孕或急性C型肝炎病毒感染，但她的產前實驗室結果顯示C型肝炎抗體和病毒量檢測呈陽性，並不表示為正常懷孕。該患者的肝酵素水平輕度升高，在懷孕期間需要額外考慮；然而，懷孕期間導致肝酵素升高的大多數情況都是在懷孕後期出現的。
子癇前症在妊娠 20 週前無法診斷，通常伴隨血壓升高和蛋白尿。在具有嚴重特徵和肝酵素升高的子癇前症中，還可能存在其他實驗室紊亂，例如血小板減少<100×109/L和溶血證據。這些發現顯示存在溶血、肝酵素水平升高、血小板水平低 (hemolysis, elevated liver enzyme levels, low platelet levels, HELLP）綜合症候。
妊娠期急性脂肪肝通常在妊娠晚期或產後不久被診斷出來，但也有罕見病例發生在妊娠中期。該患者的孕週為7週1天，與子癇前症和妊娠期急性脂肪肝均不符。
大多數C型肝炎病例是經皮傳播的，特別是透過靜脈注射毒品或輸血傳播。性傳播極為罕見，但並非不可能。對於長期一夫一妻制的伴侶感染 HCV 的人，每年傳播的風險為 0%-0.6%。然而，對於參與高風險性行為的人（例如，多個短期伴侶、有其他性傳染感染、不使用屏障式避孕或涉及創傷的性行為），風險每年增加高達 1.8%。 HIV 合併感染病人的傳播風險最高。
約 15%-45% 的急性C型肝炎患者無需治療即可清除感染；然而，其餘的人會發展為慢性感染，慢性感染的定義是感染持續時間超過 6 個月。在慢性C型肝炎患者中，15%-30%會在20年內出現明顯的肝功能障礙，如肝硬化。圖2是一張光學顯微照片，顯示了另一位患者的肝硬化。
對於活動性 HCV 感染患者，選擇的治療方法是使用直接作用抗病毒 (DAA) 藥物。有關治療適應症、持續時間和成功率的更多詳細資訊超出了本討論的範圍。治療的最終目標是治癒疾病，90% 以上的患者可以實現這一目標。因此，早期識別 HCV 感染至關重要。
對於疑似 HCV 感染的患者，透過C型肝炎抗體測試完成篩檢（圖 3）。對於近期疑似暴露的人或抗體檢測呈陽性的人，將進行C型肝炎 RNA 的後續檢測。存在C型肝炎 RNA 的陽性抗體測試者可確認活動性感染，儘管很難確定這是否代表急性或慢性感染。不存在C型肝炎 RNA但抗體檢測陽性者顯示先前感染C型肝炎病毒；然而，C型肝炎 RNA 檢測應在 2-3 週內重複進行，以考慮在感染早期階段無法檢測到病毒量的可能性。
肝酵素經常（但不一定）升高，在急性感染時通常達到正常上限的 10 倍高峰。慢性感染通常以C胺酸轉氨酶水平為特徵，該水平可能持續升高或在正常水平和升高水平之間波動。多達 30% 的慢性C型肝炎患者在篩檢時肝酵素水平正常。
由於無症狀感染的頻率很高，因此適當的常規篩檢對於在肝損傷出現之前檢測 HCV 感染至關重要。根據美國疾病管制與預防中心的指南，所有生活在C型肝炎盛行率大於 0.1% 或盛行率未知地區的 18 歲或以上成年人，一生中應至少接受一次C型肝炎檢測C型肝炎。也建議對任何年齡的C型肝炎高風險患者進行一次性篩檢，例如1987 年之前接受過濃縮凝血因子或1992 年7 月之前接受過血液製品輸注或器官移植的患者。C型肝炎：透過從確診的HCV 陽性患者輸血、透過針刺/銳器或黏膜接觸HCV 陽性血液，或透過HCV 陽性母親所生的嬰兒也應接受一次性檢測。存在C型肝炎持續危險因子的患者，例如HIV 感染者、正在使用靜脈注射藥物或共用針頭/注射器或藥物製劑設備的患者、正在接受維持性透析的患者以及丙氨酸氨基轉移酶水平持續升高的患者，應定期接受C型肝炎檢測。即使沒有任何危險因素，任何要求C型肝炎檢測的患者都不應被拒絕。
此外，居住在C型肝炎盛行率大於 0.1% 或盛行率未知地區的所有孕婦都應接受C型肝炎篩檢。此建議適用於每次妊娠，無論早期妊娠是否進行過檢測。根據孕婦的普遍篩檢建議，本例患者被診斷出HCV 感染。
HCV 感染的預防主要圍繞著透過安全處理銳器和血液製品來預防暴露。使用屏障式避孕法—特別是對於性行為過程中血液暴露風險較高的人，例如男男性行為者—可以幫助降低C肝病毒傳播的風險。由於其中一方感染 HCV 的一夫一妻制異性夫婦之間發生性傳播的風險較低，因此沒有關於在這種情況下使用屏障式避孕工具的具體指導。
過去，聚乙二醇干擾素α (pegylated interferon alpha) 和利巴韋林 (ribavirin) 聯合療法通常用於治療活動性HCV感染。最近，DAA 藥物取代了這些藥物，因為它們更容易使用、安全性更好且更有效。多種 DAA 方案已獲得批准。不幸的是，這些藥物尚未在懷孕期間得到充分研究，也未被批准在懷孕期間使用。母胎醫學會 (SMFM) 建議妊娠期C型肝炎的治療應保留在臨床試驗中。
HCV 與早產、低出生體重和妊娠期肝內膽汁淤積等不良後果有關。受影響的母親和嬰兒在分娩前或分娩過程中發生垂直傳播的風險約為 5.8%；然而，同時感染愛滋病毒的女性的風險要高得多。分娩方式似乎不會影響垂直傳播的風險，而母胎醫學會 (SMFM) 不建議將 HCV 感染作為剖腹產的唯一指徵。妊娠期間C型肝炎的監測超出了本討論的範圍，但通常不建議進行一系列肝功能測試或病毒載量評估。
此病例中的患者足月產下健康嬰兒。分娩後再次進行C型肝炎 RNA 檢測，結果呈現陰性，表示感染已自發性清除。該嬰兒在 1 個月和 2 個月大時接受了C型肝炎 RNA 篩檢，兩次檢測均為陰性。
問題 1（共 2 題）
活動性 HCV 感染的篩檢和診斷是透過下列哪一項完成的？
C型肝炎抗體和肝臟酵素檢測
單獨C型肝炎抗體
C型肝炎抗體和C型肝炎RNA
單獨的C丙型肝炎RNA
單獨肝酵素組
問題 2（共 2 題）
這些患者中哪些應該接受C型肝炎篩檢？
健康的 25 歲男性，之前從未接受過C型肝炎篩檢
一名 25 歲愛滋病毒陽性男性，與其他男性發生性關係，最後一次接受C型肝炎篩檢是在 2 年前
一名 57 歲女性，患有 IV 期透析依賴性慢性腎臟病，最後一次接受C型肝炎篩檢是在一年前
一名 25 歲女性 (G2P1001) 進行首次產前檢查，她最後一次接受C型肝炎篩檢是在 2 年前的上一次懷孕期間
上述所有的人
問題 1（共 2 題）
活動性 HCV 感染的篩檢和診斷是透過下列哪一項完成的？
您的同行選擇了：
C型肝炎抗體和肝臟酵素檢測 23%
單獨C型肝炎抗體 4%
C型肝炎抗體和C型肝炎RNA 66%
單獨的C型肝炎RNA 6%
單獨肝酵素組 1%
C型肝炎抗體檢測呈陽性表示既往有 HCV 感染或目前處於活動性感染；因此，單獨而言，該測試不足以診斷活動性 HCV 感染。 C型肝炎 RNA 檢測呈陽性且C型肝炎抗體檢測呈陽性表示目前有活動性感染。
問題 2（共 2 題）
這些患者中哪些人應該接受C型肝炎篩檢？
您的同行選擇了：
健康的 25 歲男性，之前從未接受過C型肝炎篩檢 0%
一名 25 歲愛滋病毒陽性男性，與其他男性發生性關係，最後一次接受C型肝炎篩檢是在 2 年前 21%
一名 57 歲女性，患有 IV 期透析依賴性慢性腎臟病，最後一次接受了肝炎篩檢是 C 1年前 2%
一名 25 歲女性 (G2P1001) 進行首次產前檢查，最後一次進行丙型肝炎篩檢是在 2 年前的上一次懷孕期間 3%
以上所有人皆是 74%
所有這些患者都有資格接受C型肝炎篩檢。所有 18 歲或以上的患者一生中應至少接受一次C型肝炎篩檢，除非他們來自C型肝炎盛行率低於 0.1% 的地區。此外，有愛滋病毒感染等危險因子或正在接受血液透析的患者應接受常規、定期的C型肝炎檢測。所有孕婦在每次懷孕期間都應進行C型肝炎篩檢，除非她們來自C型肝炎盛行率低於 0.1% 的地區。
以上所表達的任何觀點均為作者自己的觀點，不一定反映 WebMD 或 Medscape 的觀點。
引用此內容：疲勞、疼痛和多個新性伴侶 – Medscape – 2024 年 2 月 20 日。
Fatigue, Pain, and Multiple New Sexual Partners
Allan Dong, MD; Jing Wang, MD / February 20, 2024 / Drugs & Diseases / Medscape / Case Challenges
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
Background
A 29-year-old woman presents with a 2-week history of fatigue, nausea, and muscle aches. She attributes her symptoms to pregnancy after a home test was positive 1 week ago. This is her first pregnancy. She has regular periods and is confident in the date of her last menstrual period (LMP). Based on her LMP, she is 7 weeks and 1 day pregnant at the time of her presentation.
She reports that her appetite has been somewhat diminished for the past few weeks but does not report any other symptoms, including fever, chills, abdominal pain, chest pain, shortness of breath, headache, constipation, diarrhea, or urinary symptoms. The patient states that this is an unplanned pregnancy. She is married to a long-time male partner; however, she states that she has an open marriage. She reports intercourse with two men and three women within the past year. She has had intercourse with one new male and one new female partner in the past month. She reports that she and her partners use barrier contraceptive methods only rarely.
Her medical history is unremarkable, and she has not had any surgeries in the past. She is not taking any medications. She reports a childhood allergy to penicillin. She received prior treatment for both chlamydia and gonorrhea. She does not report a history of intravenous drug use.
During her annual visit 5 months earlier, she had no complaints. Routine laboratory results were within normal limits, and sexually transmitted infection screening tests for chlamydia, gonorrhea, HIV infection, syphilis, hepatitis B, and hepatitis C were negative at that visit.
Physical Examination and Workup
Upon examination, the patient is alert and oriented and in no acute distress. She has a temperature of 99.1 °F (37.28 °C), a pulse of 95 beats/min, a blood pressure of 102/60 mm Hg, a respiration rate of 16 breaths/min, and an oxygen saturation of 99% on room air. No scleral icterus, jaundice, or lymphadenopathy is noted. Heart and lungs are clear to auscultation. Her abdomen is soft, nontender to palpation, and without hepatosplenomegaly. She has trace pedal edema, but the remainder of her examination is largely unremarkable.
Routine laboratory studies and a prenatal panel reveal these values:
- Blood type: A+
- Antibody screen: Negative
- White blood cell count: 6.8 × 109/L (reference range, 4.5-11.0 × 109/L)
- Hemoglobin level: 12.1 g/dL (reference range, 11.6-15 g/dL)
- Hematocrit: 36.7% (reference range, 35.5%-44.9%)
- Platelet count: 230 × 109/L (reference range, 150-400 × 109/L)
- Creatinine level: 0.41 mg/dL (reference range, 0.5-1.1 mg/dL)
- Glucose level (random): 92 mg/dL (fasting reference range, 70-99 mg/dL)
- Alanine aminotransferase level: 221 U/L (reference range, 7-56 U/L)
- Aspartate aminotransferase level: 60 U/L (reference range, 8-33 U/L)
- Rubella immunoglobulin G level: 84.7 IU/mL (reference range, > 9 IU/mL)
- Urine culture: 20-50,000 colony-forming units/mL, with no predominating organism
Additional test results are pending.
On the basis of these findings only, which is the most likely diagnosis?
Acute fatty liver of pregnancy
Preeclampsia
Normal pregnancy
Acute hepatitis C
Chronic hepatitis C
On the basis of these findings only, which is the most likely diagnosis?
Your Peers Chose:
Acute fatty liver of pregnancy 20%
Preeclampsia 3%
Normal pregnancy 16%
Acute hepatitis C 51%
Chronic hepatitis C 10%
Discussion
The results of a hepatitis C antibody test and a hepatitis C RNA polymerase chain reaction (PCR) test were reactive. Test results for HIV, gonorrhea, chlamydia, and hepatitis B were negative, as were rapid plasma reagin test results. Thus, this patient most likely has an acute hepatitis C virus (HCV) infection. The fact that she was screened 5 months earlier and had negative test results indicates that this is presumably a new, acute HCV infection. In the absence of prior test results, distinguishing between an acute HCV infection and an exacerbation of a chronic infection is more challenging.
As many as 80% of patients with acute hepatitis C do not present with any symptoms. Of those who do have symptoms, most present with nonspecific ones, such as fever, fatigue, decreased appetite, nausea, vomiting, or abdominal pain. Some patients have dark urine, pale feces, or joint pain.[2] Although jaundice is commonly associated with hepatitis, only about 5% of patients with hepatitis C present with jaundice.[3] Figure 1 shows HCV-related jaundice in a different patient.
The nonspecific presenting symptoms of hepatitis C are easily confused with those of other conditions, such as symptoms of early pregnancy, as in the patient in this case. Although her symptoms may be attributable to either her pregnancy or an acute HCV infection, her prenatal laboratory results that show positive hepatitis C antibodies and viral load are not indicative of a normal pregnancy. This patient’s mild elevation in liver enzyme levels requires additional consideration in pregnancy; however, most conditions during pregnancy that result in elevated liver enzymes arise later in gestation.
Preeclampsia cannot be diagnosed earlier than 20 weeks’ gestation and is usually accompanied by elevated blood pressure and proteinuria. In preeclampsia with severe features and elevated liver enzymes, additional laboratory derangements such as thrombocytopenia < 100 × 109/L and evidence of hemolysis may also be present. These findings are indicative of HELLP (hemolysis, elevated liver enzyme levels, low platelet levels) syndrome.
Acute fatty liver of pregnancy is typically diagnosed in the third trimester or the immediate postpartum period, although rare cases in the second trimester have been reported. This patient’s gestational age of 7 weeks 1 day is inconsistent with both preeclampsia and acute fatty liver of pregnancy.
Most cases of hepatitis C are transmitted percutaneously, particularly through intravenous drug use or blood transfusion. Sexual transmission is extremely rare, although not impossible. In persons with a long-term monogamous partner infected with HCV, the risk for transmission is 0%-0.6% per year. However, in those who participate in high-risk sexual behavior (eg, multiple short-term partners, presence of other sexually transmitted infections, nonuse of barrier contraception, or sex practices involving trauma), increases the risk up to 1.8% per year. Patients with HIV coinfection are at highest risk for transmission.
Approximately 15%-45% of patients who have acute hepatitis C clear the infection without treatment; however, the remainder will develop a chronic infection, which is defined as the persistence of infection for longer than 6 months. In patients with chronic hepatitis C, 15%-30% will develop significant liver dysfunction, such as cirrhosis, within 20 years. Figure 2 is a light micrograph that shows hepatic cirrhosis in a different patient.
In patients with an active HCV infection, the treatment of choice is the use of direct acting antiviral (DAA) agents. Further details about treatment indications, duration, and success rates are beyond the scope of this discussion. The ultimate goal of treatment is disease cure, which can be accomplished in over 90% of patients. Thus, early recognition of HCV infection is crucial.
In patients with suspected HCV infection, screening is accomplished with a hepatitis C antibody test (Figure 3). In those with suspected recent exposure, or for those who test positive on the antibody test, follow-up testing for hepatitis C RNA is performed. A positive antibody test with the presence of hepatitis C RNA confirms an active infection, although it can be difficult to determine whether this represents an acute or chronic infection. A positive antibody test without the presence of hepatitis C RNA suggests a prior HCV infection; however, hepatitis C RNA testing should be repeated in 2-3 weeks to account for the possibility of undetectable viral load in the early stages of infection.
Liver enzymes are frequently (but not necessarily) elevated, usually reaching a peak of 10 times the upper limit of normal in acute infection. Chronic infection is often characterized by alanine aminotransferase levels that may either remain persistently elevated or fluctuate between normal and elevated levels. As many as 30% of patients with chronic hepatitis C have normal liver enzyme levels when screened.
Because of the frequency of asymptomatic infection, proper routine screening is vital to detect HCV infection before the development of liver damage. According to guidelines from the Centers for Disease Control and Prevention, all adults aged 18 years or older who live in areas where the prevalence of hepatitis C is greater than 0.1% or where the prevalence is unknown should be tested at least once in their lifetime for hepatitis C. One-time screening is also recommended for patients of any age at high risk for hepatitis C, such as those who received clotting factor concentrates before 1987 or blood product transfusions or organ transplants prior to July 1992. Patients who have been exposed to hepatitis C via blood transfusion from a confirmed HCV-positive patient, by needle-stick/sharps or mucosal exposure to HCV-positive blood, or by being born to an HCV-positive mother should also undergo one-time testing. Patients with ongoing risk factors for hepatitis C, such as those with HIV infection, those who are using intravenous drugs or sharing needles/syringes or drug preparation equipment, those who are receiving maintenance dialysis, and those who have persistently elevated alanine aminotransferase levels, should receive periodic hepatitis C testing. Any patient who requests hepatitis C testing should not be denied, even in the absence of any risk factors.
In addition, all pregnant women who live in areas where the prevalence of hepatitis C is greater than 0.1% or where the prevalence is unknown should receive screening for hepatitis C. This recommendation applies to each pregnancy, regardless of prior testing in earlier pregnancies. HCV infection was diagnosed in the patient in this case as a result of universal screening recommendations for pregnant women.
Prevention of HCV infection revolves primarily around exposure prevention through the use of safe handling of sharps and blood products. Barrier contraceptive use — particularly in those who are at high risk for blood exposure during sex, such as in men who have sex with men — can help reduce the risk for HCV transmission. Owing to the low risk for sexual transmission between monogamous, heterosexual couples in which one partner is infected with HCV, no specific guidance on barrier contraceptive use in this setting exists.[4]
In the past, pegylated interferon alpha and ribavirin combination therapy was typically used to treat active HCV infection.[1] More recently, DAA agents have replaced these drugs as they are easier to use, have a better safety profile, and are more effective. Several DAA regimens have been approved.[6] Unfortunately, these agents have not been well studied in pregnancy and are not approved for use in pregnancy. The Society for Maternal-Fetal Medicine (SMFM) recommends that treatment for hepatitis C in pregnancy be reserved for clinical trial settings.
HCV has been associated with adverse outcomes such as preterm birth, low birth weight, and intrahepatic cholestasis of pregnancy. The risk for vertical transmission between an affected mother and her infant before or during delivery is approximately 5.8%; however, the risk is significantly higher in women who are coinfected with HIV. The mode of delivery does not seem to affect the risk for vertical transmission, and the SMFM does not recommend that HCV infection be used as the sole indication for cesarean delivery. Monitoring of hepatitis C during pregnancy is beyond the scope of this discussion, but serial liver function tests or viral load assessments are generally not recommended.
The patient in this case delivered a healthy infant at full term. Repeat hepatitis C RNA testing after the delivery was negative, which indicated a spontaneous clearance of infection. The infant was screened for hepatitis C RNA at 1 and 2 months of age, and both tests were negative.
Question 1 of 2
Screening for and diagnosis of active HCV infection are accomplished with which of these?
Hepatitis C antibody and liver enzyme panel
Hepatitis C antibody alone
Hepatitis C antibody and hepatitis C RNA
Hepatitis C RNA alone
Liver enzyme panel alone
Question 2 of 2
Which of these patients should be screened for hepatitis C?
A healthy 25-year-old man who has never been screened for hepatitis C before
A 25-year-old HIV-positive man who has sex with other men, who was last screened for hepatitis C 2 years ago
A 57-year-old woman who has stage IV, dialysis-dependent chronic kidney disease, who was last screened for hepatitis C 1 year ago
A 25-year-old woman (G2P1001) presenting for a first prenatal visit, who was last screened for hepatitis C in her previous pregnancy 2 years earlier
All of the above
Question 1 of 2
Screening for and diagnosis of active HCV infection are accomplished with which of these?
Your Peers Chose:
Hepatitis C antibody and liver enzyme panel 23%
Hepatitis C antibody alone 4%
Hepatitis C antibody and hepatitis C RNA 66%
Hepatitis C RNA alone 6%
Liver enzyme panel alone 1%
A positive hepatitis C antibody test indicates either a prior HCV infection or a current active infection; thus, in isolation, this test is insufficient to diagnose an active HCV infection. A positive hepatitis C RNA test with a positive hepatitis C antibody test indicates a current active infection.
Question 2 of 2
Which of these patients should be screened for hepatitis C?
Your Peers Chose:
A healthy 25-year-old man who has never been screened for hepatitis C before 0%
A 25-year-old HIV-positive man who has sex with other men, who was last screened for hepatitis C 2 years ago 21%
A 57-year-old woman who has stage IV, dialysis-dependent chronic kidney disease, who was last screened for hepatitis C 1 year ago 2%
A 25-year-old woman (G2P1001) presenting for a first prenatal visit, who was last screened for hepatitis C in her previous pregnancy 2 years earlier 3%
All of the above 74%
All of these patients qualify for hepatitis C screening. All patients aged 18 years or older should be screened for hepatitis C at least once in their lifetime unless they are from an area with a hepatitis C prevalence of less than 0.1%. In addition, patients who have risk factors, such as HIV infection or who are undergoing hemodialysis, should receive routine, periodic hepatitis C testing. All pregnant women should be screened for hepatitis C during each pregnancy unless they are from an area where the prevalence of hepatitis C is less than 0.1%.
Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Fatigue, Pain, and Multiple New Sexual Partners – Medscape – Feb 20, 2024.