Infectious disease, immune disorders, and hematological disorders

PTA role: The PTA carries out the plan of care established by the supervising PT - collecting data, monitoring the patient’s response, and reporting changes or adverse responses back to the PT. The PTA does not evaluate, re-evaluate, or modify the plan of care independently.

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

Medical management

• Antiretroviral therapy (ART)
  • Action: Prevents HIV from replicating, lowers viral load, and preserves immune function.
• Opportunistic infection prophylaxis
  • Action: Prevents infections that occur when the immune system is severely weakened.
• Vaccinations and supportive care
  • Action: Reduces the risk of preventable infections and promotes overall health.

Signs and symptoms

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

PT implications

Because immune suppression and cardiac or autonomic involvement vary with disease stage, exercise intensity and infection-control precautions should be adjusted accordingly.

• Exercise considerations
  • Moderate aerobic and resistance exercise is beneficial for maintaining muscle mass and function.
  • Avoid high-intensity exercise in patients with advanced disease.

Watch for: New or worsening fatigue, or an abnormal heart rate or blood pressure response (autonomic dysfunction), during exercise. Stop the activity and notify the supervising PT.

• 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 bacterium 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

Medical management

• Antibiotics (first-line treatment)
  • Action: Kill or inhibit the growth of Staphylococcus bacteria to eliminate infection.
• Incision and drainage (for abscesses)
  • Action: Removes pus and infected material to reduce bacterial load and promote healing.

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

Because staph infections range from localized skin infections to life-threatening sepsis, PT implications shift with the severity and site of infection.

• 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

Medical management

• Antibiotics (first-line treatment)
  • Action: Kill or inhibit the growth of Streptococcus bacteria, eliminating the infection and preventing complications.
• Alternative antibiotics (penicillin allergy)
  • Action: Eliminate streptococcal bacteria when first-line antibiotics cannot be used.
• Supportive therapy
  • Action: Reduces pain, fever, and inflammation while the infection resolves.

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

Because strep infections can trigger autoimmune complications like rheumatic fever, PT implications focus on monitoring for cardiac involvement and supporting recovery.

• Rheumatic fever development
  • Can cause carditis, which increases cardiac risk during exercise; avoid overexertion.

Watch for: New or worsening fatigue, dyspnea, or chest pain during exercise in a patient recovering from rheumatic fever. Stop the activity and notify the supervising PT.

• 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.

Staph vs. strep at a glance

Feature	Staphylococcal infection	Streptococcal infection
Organism	Staphylococcus aureus, found on the skin and mucous membranes; MRSA is a drug-resistant strain	Group A strep (throat and skin infections) and group B strep (neonatal infections)
Key complications	Boils and abscesses, cellulitis, osteomyelitis, pneumonia, sepsis	Scarlet fever, rheumatic fever (carditis), necrotizing fasciitis; neonatal sepsis (group B)
Precautions beyond standard	Contact precautions (gown and gloves) for a major draining wound or MRSA	Group A: droplet precautions for pneumonia or invasive disease, contact plus droplet for a major draining wound, until 24 hours after effective antibiotics start; group B: standard precautions only
PT focus	Weight-bearing restrictions with osteomyelitis; reconditioning after sepsis	Monitoring for cardiac signs after rheumatic fever; wound care after necrotizing fasciitis debridement

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

Medical management

• Iron supplementation
  • Action: Provides iron needed for hemoglobin production, increasing the blood’s oxygen-carrying capacity.
• Vitamin replacement therapy
  • Action: Replaces deficient vitamins needed for red blood cell production.
• Blood transfusion (severe anemia)
  • Action: Rapidly increases red blood cell count and oxygen delivery to tissues.

Signs and symptoms

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

PT implications

Because reduced oxygen-carrying capacity limits exercise tolerance, PT implications center on pacing intensity to symptoms and monitoring for orthostatic changes.

• Exercise considerations
  • Mild-to-moderate, symptom-limited exercise is safe and beneficial; high-intensity exercise is a precaution - not an absolute contraindication - due to decreased oxygen-carrying capacity.
  • Monitor vital signs to prevent dizziness or syncope.

Watch for: Dizziness, syncope, chest pain, or a significant drop in blood pressure during exercise. Stop the activity and notify the supervising PT.

• Orthostatic hypotension
  • Encourage slow positional changes
  • Provide external support of an 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

Medical management

• Blood transfusions
  • Action: Increase the number of normal red blood cells, improve oxygen delivery, and reduce complications such as stroke and severe anemia.
• Supportive and disease-modifying therapy
  • Action: Prevents complications, reduces pain crises, and improves quality of life.

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

Because vaso-occlusion can be triggered by overexertion, dehydration, or cold exposure, PT implications focus on preventing a sickle cell crisis while still promoting safe activity.

• Exercise precautions
  • Mild-to-moderate, symptom-limited exercise is appropriate; high-intensity exercise or overexertion is the precaution, since it can trigger a sickle cell crisis.
  • Hydration is critical to prevent red blood cell sickling.
• Pain management
  • Use gentle ROM exercises and warm compresses during pain episodes
  • TENS and relaxation techniques can help with pain relief

Watch for: Sudden weakness, facial droop, or speech difficulty - signs of stroke. This is a medical emergency: stop the activity immediately, notify the supervising PT, and call for emergency assistance.

• Cold intolerance
  • Avoid cold environments, as cold can trigger vasoconstriction and pain crises