Infectious disease, immune disorders, and hematological disorders

HIV/AIDS

Overview

• HIV (Human Immunodeficiency Virus) attacks the immune system, specifically CD4+ T-cells, leading to immunosuppression
• AIDS (Acquired Immunodeficiency Syndrome) is the advanced stage of HIV, characterized by severe immune system compromise and opportunistic infections

Signs and symptoms

• Fatigue, weight loss, fever, night sweats
• Chronic diarrhea
• Opportunistic infections (e.g., pneumonia, tuberculosis)
• Peripheral neuropathy
• Kaposi’s sarcoma (vascular skin tumors)
• Muscle wasting and weakness

PT implications

• Exercise considerations
  • Moderate aerobic and resistance exercise is beneficial for maintaining muscle mass and function.
  • Avoid high-intensity exercise in patients with advanced disease.
  • Monitor for excessive fatigue and autonomic dysfunction (HR, BP).
• Neuropathy management
  • Balance training and fall prevention strategies.
  • Pain management techniques (TENS, massage, stretching).
• Infection control
  • Standard precautions (gloves, hand hygiene) when treating open wounds.
  • Avoid over-fatiguing the patient to reduce susceptibility to infections.

Staphylococcal infection (staph infection)

Overview

• Caused by Staphylococcus aureus, a common bacteria found on the skin and mucous membranes.
• Can cause localized infections (boils, cellulitis) or systemic infections (sepsis, pneumonia, osteomyelitis)
• Methicillin-resistant Staphylococcus aureus (MRSA) is a drug-resistant strain

Signs and symptoms

• Skin infections: Red, swollen, painful lesions (abscesses, boils)
• Osteomyelitis: Bone infection causing deep pain, fever, and localized swelling
• Sepsis: Fever, hypotension, multi-organ failure

PT implications

• Infection control
  • Use contact precautions (gloves, gowns) when treating open wounds.
  • Disinfect equipment properly.
• Osteomyelitis management
  • Avoid weight-bearing on the affected limb until cleared by the physician.
  • Implement gradual mobility training.
• Post-infection recovery
  • Monitor for persistent fatigue and weakness post-sepsis.
  • Implement strength training with caution in recovering patients.

Streptococcal infection (strep infection)

Overview

• Caused by Streptococcus bacteria. Common types include:
  • Group A Streptococcus (GAS): Causes strep throat, rheumatic fever, necrotizing fasciitis
  • Group B Streptococcus (GBS): Can cause neonatal infections and sepsis

Signs and symptoms

• Strep throat: Sore throat, fever, swollen lymph nodes
• Scarlet fever: Red rash, high fever, sore throat
• Rheumatic fever: Post-strep autoimmune response affecting joints, heart, skin, CNS
• Necrotizing fasciitis: Rapidly spreading soft tissue infection

PT implications

• Rheumatic fever development
  • Can cause carditis → monitor for fatigue, dyspnea during exercise.
  • Avoid overexertion due to potential cardiac involvement.
• Necrotizing fasciitis development
  • Requires surgical debridement → PT for wound care and functional recovery.
• Post-infection weakness
  • Strengthening and endurance training for patients recovering from severe strep infections.

Anemia

Overview

• Condition characterized by low red blood cell (RBC) count or hemoglobin, leading to decreased oxygen delivery to tissues
• Causes include iron deficiency, chronic disease, or blood loss

Signs and symptoms

• Fatigue, weakness
• Pallor (pale skin)
• Shortness of breath
• Dizziness, hypotension
• Tachycardia

PT implications

• Exercise considerations
  • Avoid high-intensity exercise due to decreased oxygen-carrying capacity.
  • Monitor vital signs to prevent dizziness or syncope.
• Orthostatic hypotension
  • Encourage slow positional changes
  • Provide external support of abdominal binder or compression stockings
• Address underlying causes
  • Work with a healthcare team if anemia is due to chronic disease (e.g., kidney disease, GI disorders).

Sickle cell anemia

Overview

• Genetic blood disorder causing abnormally shaped RBCs, leading to vaso-occlusion and reduced oxygen delivery
• Common in individuals of African, Mediterranean, Middle Eastern, and Indian descent

Signs and symptoms

• Pain crises: Severe pain episodes due to blocked blood flow
• Fatigue and anemia: Chronic low RBC count leads to weakness
• Swelling in hands/feet: Due to poor circulation.
• Increased risk of stroke: Due to impaired blood flow to the brain

PT implications

• Avoid overexertion
  • High-intensity exercise can trigger a sickle cell crisis.
  • Hydration is critical to prevent red blood cell sickling.
• Pain management
  • Use gentle ROM exercises, warm compresses during pain episodes.
  • TENS and relaxation techniques can help with pain relief.
• Monitor for stroke signs
  • Sudden weakness, facial droop, speech difficulty → medical emergency.
• Cold intolerance
  • Avoid cold environments, as cold can trigger vasoconstriction and pain crises.