A 26-year-old woman comes to the office due to a flulike illness with low-grade fever, malaise, nausea, and anorexia. She came back from a trip to Honduras a week ago, and her symptoms started 2 days prior to her return. The patient has no significant medical history and takes no medications. She occasionally smokes marijuana and has used injection drugs in the past. She has had several sexual partners and currently lives with her boyfriend. Temperature is 37.9 C (100.2 F), blood pressure is 121/78 mm Hg, and pulse is 86/min. The patient has scleral icterus. Cardiopulmonary examination is unremarkable. The liver edge, palpated 4 cm below the right costal margin, is smooth and tender. Laboratory results are as follows: After discussing the findings, the patient says she is worried that she may transmit the disease to her boyfriend. Which of the following interventions for the boyfriend is most likely to decrease his risk of disease acquisition?

Question

A 26-year-old woman comes to the office due to a flulike illness with low-grade fever, malaise, nausea, and anorexia.  She came back from a trip to Honduras a week ago, and her symptoms started 2 days prior to her return.  The patient has no significant medical history and takes no medications.  She occasionally smokes marijuana and has used injection drugs in the past.  She has had several sexual partners and currently lives with her boyfriend.  Temperature is 37.9 C (100.2 F), blood pressure is 121/78 mm Hg, and pulse is 86/min.  The patient has scleral icterus.  Cardiopulmonary examination is unremarkable.  The liver edge, palpated 4 cm below the right costal margin, is smooth and tender.  Laboratory results are as follows:  After discussing the findings, the patient says she is worried that she may transmit the disease to her boyfriend.  Which of the following interventions for the boyfriend is most likely to decrease his risk of disease acquisition?

Quizplus · Accepted Answer

Explanation: This patient's presentation and laboratory findings are consistent with both acute hepatitis A virus infection (markedly elevated transaminases, positive hepatitis A IgM antibody [Ab], negative hepatitis A IgG Ab, recent travel to Honduras) and prior hepatitis B virus infection (positive hepatitis B core Ab, positive hepatitis B surface Ab, history of intravenous drug use). Since the introduction of routine hepatitis A vaccination in the United States, infection rates have fallen significantly, but disease transmission remains a risk for a number of groups, including international travelers, men who have sex with men, illicit drug users, and those with household or sexual contact with infected persons. Transmission occurs most frequently via the fecal-oral route, although sexual and blood-borne transmission can also occur. Postexposure prophylaxis with hepatitis A vaccine or hepatitis A immune globulin should be considered in a number of groups, including: Close personal contacts (eg, sexual contacts, household contacts) of hepatitis A-infected patients Child care center contacts (eg, staff and children) where staff, children, or household contacts of attendees have been infected Food preparation workers whose coworkers have been infected Prophylaxis should be given within 2 weeks of exposure; in general, younger patients (age <40) should receive hepatitis A vaccine, whereas older patients (age >41) should receive hepatitis A immune globulin. < > (Choice A) Although sexual transmission of hepatitis A virus may occur occasionally, barrier contraceptive use alone would not provide adequate protection against the most common route of transmission (fecal-oral). (Choices C, D, and E) This patient's viral markers imply previous hepatitis B infection (core Ab) with resolution (surface Ab), making further vaccination and treatment for hepatitis B unnecessary. Postexposure prophylaxis with hepatitis B immune globulin and vaccine would be administered to a patient with a percutaneous or sexual exposure to an individual with positive hepatitis B surface antigen. viral markers Educational objective: Postexposure prophylaxis with either hepatitis A vaccine or hepatitis A immune globulin should be considered in a number of groups, including those with close personal contact (eg, sexual contacts, household contacts) with infected patients. References: Hepatitis A. (http://www.ncbi.nlm.nih.gov/pubmed/23198670)

A 26-Year-Old Woman Comes to the Office Due to a Flulike