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

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

• 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 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

• 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

• 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

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

• 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 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

• 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 and 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