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Viral infections are human diseases that are caused by viruses’ penetration into the cells of the human body. Viruses themselves are microscopic life forms, consisting of a nucleic acid surrounded by a protective shell of proteins. However, such life forms have different clinical features and mechanism of pathogenesis, such as cytomegalovirus infection and hepatitis B viruses. Even though the aforementioned viruses are similar by possible liver damage symptoms, there are also differences between them. Such distinct characteristics include connectedness of the severity of the disease with the immune system condition for cytomegalovirus or a skin yellowness feature for hepatitis B.
Therefore, this paper provides a comparative analysis of the two above-indicated viruses.
Cytomegalovirus infection is a widespread human infectious disease with different transmission mechanisms. In most cases, the infection is immune-competent and occurs without clinical symptoms in a latent form according to Townsend et al. (2013). If immuno-suppression is induced by various factors, the virus causes disease generalized forms. The causative agent is cytomegalovirus, cytomegalovirus hominis. It is a pathogen that belongs to the family of herpes viruses.
In contrast, as Kim, Revill and Ahn (2011) stated, hepatitis B is a contagious liver disease that occurs in different clinical variants from asymptomatic carriage to the destruction of liver parenchyma. It cannot be latent for a lot of time as compared to cytomegalovirus. The virus of autoimmune hepatitis belongs to the genus orthohepadnavirus. In infected blood, three types of hepatitis B viruses could be find, which differ by morphological features (Ren et al. 2014).
Hence, both pathogens are viruses by nature, but because of different attributes, they cause different effect. At the same time, cytomegalovirus infection may occur in a hidden latent form for a long time, but hepatitis B is more presentable by symptoms picture.
In most cases, cytomegalovirus is asymptomatic, without causing any harm in people with normal immunity. It can lead to the so-called mononucleosis syndrome. This syndrome occurs in 20-60 days after infection and lasts for two-six weeks. It is manifested by fever, chills, fatigue, malaise and headache. Mostly, mononucleosis syndrome ends with a complete recovery (Faddan, Eltayeb & Refaiy 2011). Nevertheless, individuals with weakened immune systems may have severe diseases complications, e.g. eye disease, lung, digestive system and brain damage, which can lead to death because of cytomegalovirus, comparing to persons with healthy immune status. Infection is manifested with clinical signs of hepatomegaly, acute renal failure, prolonged fever, as well as identification of atypical mononuclear cells in the hemogram. Cytomegalovirus reactivation formed a wide spectrum of clinical manifestations ranging from an increase of the salivary glands and regional lymphadenitis to severe disseminated forms (van Zuylen et al. 2014). Most often it affects liver (hepatitis with cholestatic component), lungs (interstitial pneumonia), and a gastrointestinal tract (enterocolitis, esophagitis). In such cases, the disease resembles sepsis, accompanied by prolonged fever, symptoms of intoxication, and enlarged lymph nodes (Ross & Boppana 2012). Thus, cytomegalovirus infection is similar to hepatitis virus because its manifestations also include liver damage characteristics.
Nonetheless, hepatitis B is always initially supported with yellowness that appears on the mucous membranes of the mouth and the sclera, and then spreads throughout the skin (Ren et al. 2014). These symptoms are not relative to cytomegalovirus infections. During this period, hepatitis intoxication symptoms, such as malaise, weakness, irritability, sleep disturbances and appetite, nausea and vomiting, are marked. Patients complain of a feeling of heaviness or fullness in the epigastric and right upper quadrant. Some patients have itchy skin. Most patients have hepatomegaly, which usually corresponds to the degree of severity of the disease and the severity of cholestasis.
Therefore, liver symptoms are more manifested during diagnostics of hepatitis B due to a severity level. In contrast, manifestation symptoms of cytomegalovirus infections mostly depend on the condition of the immune status, and may occur even without liver damage component.
Cytomegalovirus excreted in the urine, saliva, breast milk, cervical secretions, and semen during primary infection and relapse. Constant shedding occurs in infected persons. Severe infection of the fetus with symptomatic manifestations at birth occurs mainly in primary maternal infection during pregnancy, but the infection (usually without clinical manifestations) can develop even when the mother has antibodies to cytomegalovirus before conception (Boeckh 2011). Postnatal infection usually occurs in infants born to mothers excreting cytomegalovirus with cervical mucus during childbirth. The virus can also be transmitted to the newborn through infected breast milk.
Hepatitis B is also excreted with different biological secrets, including blood, saliva, urine, bile, tears, breast milk, and semen. However, only blood, semen and possibly saliva represent a real epidemiological risk as in other liquids the virus concentration is very low (Hadziyannis 2011). The disease is transmitted primarily by parental blood transfusions and blood products and the use of medical instruments without sufficient effective sterilization (Ren et al. 2014). Infection may also occur as a result of tattooing, piercing the earlobes and other manipulations. vertical transmission of the parasite is also possible. Usually infection occurs during birth, but infection of the fetus in the uterus may rupture the placenta.
Risk of Acquisition to the Health Care Workers (HCW)
Medical workers who have contact with blood, especially surgeons, gynecologists, obstetricians, dentists, manipulation nurses, staff offices of blood transfusion and dialysis, laboratory staff are the first in a row to get infected with both viruses. Risk of contracting hepatitis B exists for health professionals who care for children. AT the same time, the fact of personal immune system has to be emphasized with respect to cytomegalovirus as previously explained. In this way, the risk of hepatitis is more relevant for health care workers.
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Management of Spread within Community and Health Care Setting
To prevent the contamination of hepatitis B and cytomegalovirus, there are several actions that need to be done in a health care setting. Some of them are non-specific, such as construction and rehabilitation of inpatient and outpatient facilities following the principle of sustainable architectural and planning decisions, insulation sections, wards, operating units, compliance and separation flow of patients. Additionally, sanitary measures have to be undertaken, including efficient artificial and natural ventilation, creation of standard conditions of water supply and sanitation, air conditioning, use of laminar plants, creation regulated microclimate, lighting are also needed for efficient viruses spread prevention. Management within community includes monitoring of sanitary-epidemiological regime, planned active and passive immunization of emergency passive immunization. Immunization for hepatitis B could be provided due to childbirth or early age. In contrast, vaccine for cytomegalovirus is not provided afterbirth but after a serological detection of viruses in older age.
Incidence or Occurrence within Australia and Worldwide
Olsen, Wallace and Maher (2014) found that more than 240 million individuals around the globe have chronic liver infections, and around 780,000 people die each year from acute or chronic consequences of hepatitis B. The highest prevalence of hepatitis B occurs in South Africa and East Asia (Busca & Kumar 2014). High rates of chronic infections are also found in the Amazon and the southern parts of Eastern and Central Europe, while in Western Europe and North America, less than 1% of the population is infected by hepatitis B (Olsen, Wallace & Maher 2014). Between 90,000 and 160,000 people in Australia are chronically infected with hepatitis B virus ( Olsen, Wallace & Maher 2014). Cytomegalovirus infecting 45-90% of adults with persistent lifelong latent infection worldwide. Among Australian population, 57% were tested as sero-positive to cytomegalovirus (Lanzieri 2014).
Hence, incidence of cytomegalovirus infection is spread worldwide, but clinical registered manifestations are more relative to hepatitis B, since it has not prolonged hidden form.
Total prevention of hepatitis B and cytomegalovirus infection is aimed at reduce the risk of infection by blood transfusion, control of sterile medical instruments, introduction disposable needles to mass practice of catheters, to list a few. The viruses discussed are similar by their possible spread. However, clinical manifestations of hepatitis B are more unique symptoms. On contrast, cytomegalovirus infections are more dependable on an immune system status determining progression or activation of virus. Finally, greater detection of cytomegalovirus all over the world does not correspond to a greater number of registered clinical cases of hepatitis B.