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10

Infectious Diseases

Jaime C. Paz and V. Nicole Lombard

lntroduction

A patient may be admitted to the hospital setting with an infectious

process acquired in [he community or may develop one as a complication from the hospital environment. An infectious disease process generally has a primary site of origin; however, it may result in diffuse

systemic effects that may limit the patient's functional mobility and

activity tolerance. Therefore, a basic understanding of these infectious

disease processes is useful in designing, implementing, and modifying

physical therapy treatment programs. The physical therapist may also

provide treatment for patients who have disorders resulting from

altered immunity. These disorders are mentioned in this chapter

because immune system reactions can be similar to those of infectious

disease processes (see Appendix IO-A for discussions of three common disorders of altered immunity: systemic lupus erythematosus, sarcoidosis, and amyloidosis). The objectives of this chapter are to

provide a basic understanding of the following:

'I.

Clinical evaluation of infectious diseases and altered immune

disorders, including physical examination and laboratory studies

605

606

ACUTE CARE HANDBOOK FOR I)HYSICAL lllERAlllSTS

2.

Various infectious disease processes, including etiology,

pathogenesis, clinical presentation, and management

3.

Commonly encountered altered immune disorders, includ-

ing etiology, clinical presentation, and management

4.

Precautions and guidelines that a physical therapist should

implement when treating a patient with an infectious process or

altered immunity

Definition of Terms

To facilitate the understanding of infectious disease processes, termi·

nology that is commonly used when referring to these processes is

presented in Table 10- 1 1-3

Overview of the Immune System

A person's immune system is comprised of many complex, yet syner·

gist ie, components that defend against pathogens (Table 10-2). Any

defect in this system may lead to the development of active infection.

Patients in the acute care setting often present with factors that can

create some or most of these defects, which can ultimately affect their

immune system (Table 10-3).

Evaluation

When an infectious process is suspected, a thorough patient interview

(history) and physical examination are performed to serve as a screening tool for the differential diagnosis and to help determine which laboratory tests are further required to identify a specific pathogen'

History

Potential contributing factors of the infection are sought out, such as

exposure to infectious individuals or recent travel to foreign coun·

tries. Also, a qualitative description of the symptOmatology is discerned, sllch as onset or nature of symptoms (e.g., a nonproductive versus productive cough over the past day or weeks).