Your First Assignment
You graduated from Boston University School of Public Health last spring and began working for the Massachusetts Department of Public Heath just two weeks ago. DPH was severely understaffed, and after a brief orientation you were given your first field assignment.
Your supervisor says:
"We've been following a situation in the town of Sparta about an hour an a half west of here on the turnpike. About two weeks ago they reported a case of hepatitis A. A 31 year-old woman was seen in the emergency room of the local hospital complaining of fever, nausea, and severe fatigue. She also reported that her urine was very dark, and her stools were very light in color over the past 24 hours. She had been previously healthy and had no past history of jaundice. She had a low grade fever (100.6 ° F), mild scleral icterus (the whites of her eyes were slightly yellow), and her liver was enlarged. She had no rash. Here are the results of her blood tests."
Her Blood Tests
Her Liver Function Tests
:
- ALT (alanine aminotransferase): 877 IU/L
- AST (aspartate amino transferase): 650 IU/L
- Alkaline phosphatase: 58 IU/L
- Total bilirubin: 3.4 mg/dL (range of normal values)
- Her white blood count and differential were normal.
Link to information on nterpretation of Liver Function Tests
Her Serology Tests:
- Total anti-HAV: positive
- IgM anti-HAV: positive
- Total anti-HBc: positive
- IgM anti-hepatitis B core antigen: negative
- HBs Ag: negative
- Anti-HBs: positive
- Anti-HCV: negative
Your supervisor continues:
"The hepatitis B serologic tests indicated that she had had hepatitis B in the past, but it resolved. The positive IgM anti-HAV indicates that she had an acute infection with hepatitis A. The physician reported the case to the local board of public health, and they relayed the information to us."
