Ans. b. Super infection of hepatitis E virus with chronic hepatitis B infection In the given question, patient presents with jaundice, deranged LFT (raised SGOT/SGPT), HBsAg positive, IgM anti-HEV antibodies positive and IgM antiHBc-negative. As the patient is IgM anti-HBc-negative, acute hepatitis B is ruled out. As the patient is IgM anti-HEV antibodies positive so patient is having acute Hepatitis E. In co-infection, both Hepatitis E and Hepatitis B infection occurs simultaneously. In the given question, hepatitis B is chronic and hepatitis E is acute, so it ors superinftction of hepatitis E on hepatitis B Serology of Hepatitis B Hbs Ag Indicates that the person is infected with the viruse. The infection may manifest as 'disease' either acute or chronic, or be just present as in carrier stateQ Anti-Hbs Ag With the development of antibody to Hbs Ag i.e. Anti Hbs Ag, the Hbs Ag antigen disappears from the serum: Patient is immune (with immunization Antibody develops and Hbs Ag disappears) Patient is protected Anti Hbs Ag indicates good immunityQ Anti Hbs Ag indicates protection against Hepatitis BQ Hbc Ag It is a hidden component of the viral core and is not detectable at allQ Anti-Hbc Ag Antibodies to Hbc Ag develop early in the course of diseaseQ Anti-Hbc Ag is the first antibody to appear after an acute infection and persists in serum even during the recovery phase Acute infection Antibody of IgM typeQ Chronic infection Antibody of IgG typeQ Hbe Ag Denotes high infectivityQand active diseaseQ Anti-Hbe Ag Denotes low infectivityQ