minor hepatitis B virus carrier Small three positives in hepatitis B refer to the condition where all three markers, hepatitis B surface antigen (HBsAg), hepatitis B e antibody (anti-HBe), and hepatitis B core antibody (anti-HBc), are positive in the serological test for hepatitis B virus 'two pairs and a half'. In contrast to the condition of having all three markers positive, patients with small three positives have converted from HBeAg positive to negative, and anti-HBe has become positive.

Positive HBsAg, anti HBe and anti HBc in two and a half pairs of hepatitis B tests

Virus replication is not active, but it may still be contagious

Patients with Xiao San Yang may still have impaired liver function

The purpose of treatment is to inhibit virus replication and delay the progression of the disease

Hepatitis B Little Three Positive refers to the positive state of hepatitis B surface antigen (HBsAg), hepatitis B e antibody (anti HBe) and hepatitis B core antibody (anti HBc) during the human serological examination of hepatitis B virus. Different from the big three positive patients with hepatitis B B e antigen (HBeAg) positive, the small three positive patients with HBeAg turned negative and anti HBe turned positive.

There are two possibilities for Xiao San Yang. One indicates that the patient's virus replication has been inhibited, the disease has improved, and it is a sign of good prognosis. Another possibility is that hepatitis B virus has changed. At this time, the virus DNA in the blood is still positive, and the virus is still replicating in the body, which is still infectious and may cause liver function damage to the patient.

Therefore, patients with hepatitis B B with minor three positive still need to have hepatitis B virus DNA examination and re examination on time to prevent further development of the disease and reduce the probability of complications such as liver cancer and cirrhosis.

Hepatitis B virus (HBV)

The hepatitis B virus continuously replicates after entering the human body. Once detected by the immune system, the body launches an attack to clear the virus. If the immune system gains the upper hand, the infected person's HBeAg will gradually turn negative, and anti-HBe will begin to appear, indicating a certain level of immunity and a better prognosis.

However, the "cunning" hepatitis B virus may undergo mutations, allowing the virus to evade the immune system's attack, leading to a situation where HBeAg is negative and anti-HBe is positive.

The hepatitis B virus has strong resistance to low temperatures, dryness, and ultraviolet light. It is resistant to 70% alcohol disinfection, but can be inactivated by high temperatures, sodium hypochlorite, and bleach, which can destroy the envelope of the hepatitis B virus, rendering it non-infectious and suitable for disinfection against the virus.

Sources of infection

Hepatitis B patients and asymptomatic carriers of the hepatitis B virus.

Modes of transmission

The hepatitis B virus is mainly transmitted through blood, body fluids, close daily contact, and sexual contact.

Transmission through blood and body fluids

In addition to transmission through blood transfusion and blood products, small amounts of blood from needle sticks, injections, and other sources can also spread the hepatitis B virus. Body fluids containing the hepatitis B virus, such as saliva, breast milk, semen, and secretions, can cause transmission by entering the body directly or coming into contact with damaged skin or mucous membranes. Hepatitis B virus cannot be transmitted through mosquito bites.

Close daily contact

Hepatitis B virus infections often occur within families. The so-called "close daily contact" may be a special form of bloodborne transmission resulting from minor injuries due to lack of attention in daily life. It may be transmitted through sharing toothbrushes, razors, and not through the digestive or respiratory tract.

Mother-to-child transmission

Also known as vertical transmission, mother-to-child transmission includes intrauterine infection, perinatal infection, and postpartum infection. The probability of fetal infection in the uterus is about 5%, and the virus from the mother can infect the infant through minor wounds during childbirth. After birth, the virus may be transmitted to the newborn through breast milk if the mother has nipple damage.

Sexual transmission

The virus has been detected in the semen and vaginal secretions of hepatitis B virus-infected individuals, making their partners more susceptible to hepatitis B virus infection compared to other family members.

Most of the patients with hepatitis B and Little Three Yang have no obvious symptoms. Some patients may have general fatigue, fever, anorexia, greasy aversion, abdominal distension, liver pain and other symptoms, and may also have jaundice; As the condition progresses and worsens, patients may also experience symptoms such as liver palms and spider nevi. As the condition progresses to stages such as cirrhosis and liver cancer, patients may experience severe symptoms such as malnutrition, bleeding, anemia, and endocrine disorders.

The incubation period of patients infected with hepatitis B virus ranged from 1 to 6 months, with an average of 3 months.

The following are the common symptoms of liver inflammation in patients with hepatitis B and Little Three Yang:

Fatigue: Feeling weak and fatigued throughout the body, even after sufficient rest, the fatigue cannot be relieved.

Loss of appetite: The patient's appetite has decreased compared to when they were healthy, and they are particularly disinterested in greasy foods.

Nausea and vomiting: Patients may feel discomfort in the upper abdomen, which may be accompanied by vomiting. Generally, the vomit is stomach contents.

Discomfort in the upper right abdomen: It is located on the surface of the liver, and the patient may feel dull pain, bloating, and other discomfort in this area.

Dark complexion: also known as liver disease complexion. When patients have abnormal liver function, their complexion is dark and dull, and their skin is rough and dry, which is called liver disease complexion.

Liver Palm: Patchy congestion or red spots or patches appear in the large and small fish areas of the palm, below the thumb and little finger, which turn white when pressed.

Spider mole: When liver function is abnormal, a "mole like" structure appears on the patient's body, with a red dot at the center and radiating capillaries around it, resembling spiders. It disappears after pressing the central red dot.

Jaundice: One of the typical symptoms of liver injury in patients, with yellow staining of the sclera (white eyes) and skin. Generally, the yellowing of the white eyes is more obvious and easier to detect.

Yellowing urine: It is also a common symptom of liver damage, and patients may find that their urine color has darkened.

Psychological symptoms: When liver function is severely impaired, patients may experience mental and neurological changes such as drowsiness, restlessness, and even coma.

Patients with obvious symptoms, severe illness, and jaundice should rest in bed to avoid overexertion. Bed rest can also increase liver blood flow and facilitate recovery.

A light diet with appropriate high protein, high calorie, and high vitamin foods can help with liver repair, but there is no need for excessive nutrition to prevent fatty liver. Patients should avoid drinking alcohol.

Hepatitis B "small three positive" cannot be completely cured, and current medical methods cannot completely eliminate the virus. However, it is possible to suppress virus replication and even achieve clinical cure, where after treatment cessation, HBsAg remains negative (with or without the appearance of HBsAb), HBV DNA is undetectable, and liver function is normal.

Without timely and standardized treatment, the liver of "small three positive" patients may still be damaged, and may even progress to cirrhosis or liver cancer, significantly impacting the patient's quality of life and lifespan.

As the disease progresses and the degree of liver damage increases, "small three positive" hepatitis B patients may develop various complications associated with cirrhosis.

Ascites

Ascites is the most common complication in patients with cirrhosis.

Upper gastrointestinal bleeding

Abnormal liver function, especially during cirrhosis, leads to abnormal blood flow and blood pressure, as well as abnormal clotting factors in the blood, resulting in upper gastrointestinal bleeding, a common complication of cirrhosis.

Hepatic encephalopathy

A common complication during severe hepatitis and cirrhosis, patients may exhibit varying degrees of mental and neurological symptoms.

Hepatorenal syndrome

One of the complications of chronic severe hepatitis, which may manifest as oliguria, anuria, and electrolyte abnormalities.

Diet

The diet should be healthy and balanced, with adequate energy and protein intake, while avoiding overeating, and controlling sugar and fat intake. Patients should strictly abstain from alcohol to reduce the burden on the liver and minimize liver damage.

Exercise

Moderate exercise can enhance resistance. It is advisable to engage in low-intensity exercise for a suitable duration without feeling excessively fatigued. However, patients with severe conditions are advised to rest in bed.

Lifestyle

Maintain a healthy lifestyle.

Emotional well-being

Psychological factors are important contributors to exacerbating the condition. Therefore, maintaining a healthy and positive mindset is crucial. If the disease causes distress in the patient's work and life, communication with doctors or family members is recommended.

Patients should undergo regular follow-up examinations (generally every 3 to 6 months) before, during, and after treatment to monitor changes in the disease. A small number of patients may experience certain side effects after using hepatitis B medications, and individual tolerance varies. Therefore, if any discomfort occurs after medication, prompt medical attention is necessary so that the doctor can adjust the personalized treatment plan based on the patient's condition.

For patients with positive markers of hepatitis B virus infection in their blood, they should avoid donating blood. In accordance with national regulations, they should also refrain from working in catering and childcare services.

Routine prevention

Develop good personal hygiene habits and avoid sharing items such as toothbrushes and razors with others. After contact with patients, hand hygiene should be observed.

Protection for susceptible populations

Vaccination against hepatitis B is the most crucial measure for preventing and controlling the disease. After vaccination, regular checks should be conducted to determine if protective antibodies are present in the body. If the antibodies disappear, timely re-vaccination is necessary.

For high-risk individuals who have had accidental exposure to hepatitis B virus-contaminated materials, timely administration of hepatitis B immune globulin is recommended.

For mothers infected with hepatitis B, it is essential to administer hepatitis B immune globulin immediately after the newborn's birth, along with hepatitis B vaccination. Additional injections should be given at 1 month and 6 months to prevent infection.