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
  • Other immune cells: killer (cytotoxic) T cells attach to infected cells and cancer cells and kill them, natural killer cells recognize and kill abnormal cells without first learning what they look like, and B cells produce antibodies specific to the antigen that stimulated them
• 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 for every patient: hand hygiene, plus gloves for contact with blood, body fluids, or non-intact skin. HIV itself needs no additional isolation precautions.
  • 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 (gown and gloves) for MRSA or a major draining wound that a dressing cannot contain; standard precautions otherwise.
  • 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

Hemophilia

Definitions

Hemophilia

An inherited, X-linked bleeding disorder that mainly affects males. Hemophilia A is a deficiency of clotting factor VIII; hemophilia B is a deficiency of factor IX.

Bleeding into joints (hemarthrosis) makes up 70-80% of bleeds, most often in the knees, elbows and ankles. Three or more bleeds into one joint within 6 months make it a target joint, and repeated bleeds lead to synovitis and hemophilic arthropathy.

• Signs of a joint bleed: an early tingling or unusual feeling in the joint, then swelling, warmth, pain and loss of motion; a young child may simply refuse to use the limb
• Acute bleed: replacing the missing clotting factor comes first, so the bleed is reported at once. The joint is protected and rested in its position of comfort (usually slightly flexed), with ice for short periods (not directly on the skin), compression and elevation. No heat, stretching or joint mobilization during an acute bleed: heat increases blood flow and bleeding
• After the bleed: once pain and swelling begin to subside, motion is restored gently and gradually, weight bearing is progressed with crutches, and exercise continues until pre-bleed motion and function return, ideally with factor coverage and watching for a new bleed

PTA role: New joint swelling, warmth or pain in a patient with hemophilia means stopping the exercise, protecting the joint and reporting to the PT and nursing at once, so factor can be given.