infectious diseases pta 120 pathophysiology day 16

INFECTIOUS DISEASES

PTA 120 Pathophysiology

Day 16

Objectives

Describe the reasons why infections can occur both at the cellular level and the organism level.

Define infectious diseases including signs and symptoms of each: Hepatitis HIV / AIDS Cytomegalovirus Syphilis Nosocomial Infections

Objectives

West Nile Virus Diseases which require immunity in health care

workers Botulism Influenza Meningitis

Discuss how infectious pathologies can adversely affect function requiring the modification of treatment intervention to protect the patient from worsening the condition and optimize treatment outcomes.

Objectives

Discuss the modifications and precautions that may be required for the treatment of patients with infectious disorders.

Demonstrate understanding of the PTA’s role in the disease process and infection control.

Textbooks

Pathology for Physical Therapist Assistants, Ch 10

Physical Therapy Clinical Handbook for PTAs, Section 1-6

QUICK REVIEW

Physiology of Infection

Why Do Infections Occur?

Factors involved in infectionPortal of entryVirulence of organism

Aggressiveness Toxin production

Dose (number) of pathogensIndividual condition (predisposition) to

infection

Modes of Transmission

Direct physical contact Mucous membranes Intact skin Broken skin

Indirect physical contact Inhalation Ingestion

From Christensen BL, Kockrow ED: Foundations of nursing, ed 5, 2006, St. Louis, Mosby.

When infection occurs

Phagocytosis White blood cells take in and destroy waste and

foreign material Neutrophils Macrophages

Natural Killer Cells Type of lymphocyte Can recognize body cells with abnormal membranes Found in lymph nodes, spleen, bone marrow, blood Secrete protein that breaks down cell membrane

THE PTA MUST MAKE INFORMED DECISIONS ABOUT VACCINATIONS AND

INFECTION CONTROL, AS HEPATITIS B IS A BLOOD-BORNE PATHOGEN MORE LIKELY

TO BE CONTRACTED BY HEALTH CARE WORKERS.

Why does the PTA need to know about Hepatitis?

Hepatitis

Group of liver infections and diseases caused by various viruses

Several types Hepatitis A (HAV) Hepatitis B (HBV) Hepatitis C (HCV) Hepatitis D (HDV) Hepatitis E (HEV) Hepatitis G (GEV) Alcoholic Hepatitis

Hepatitis

Hepatitis A (HAV) Transmitted through contact with body fluids, feces,

and ingestion of contaminated food and drinking water

Hepatitis D (HDV), E (HEV) and G (HGV)

Alcoholic hepatitis A chronic and serious condition of the liver caused by

extreme alcohol intake

Hepatitis B

Description CDC estimates 800,000 to 1.4 million people in U.S.

have chronic hepatitis 350,000,000 affected, 620,000 deaths worldwide

annually Males between 25 and 44 most affected Risk for infection greatest in people with

immunosuppressive disorders and health care workers Vaccinations recommended for children and health

care workers Virus lives on equipment up to 7 days OSHA and CDC recommendations for clean-up

Hepatitis B

Etiology DNA virus, blood – borne pathogen Transmitted through contact with contaminated

blood, blood products, or through sexual contact Incubation period from 6 weeks to 6 months

Symptoms Loss of appetite, nausea and vomiting Weakness, fatigue, joint and muscle pains, aching Fever, skin rash Jaundice, dark-colored urine

Hepatitis B

Treatment Prevention, vaccinations Medications

Physical Therapy Interventions

For Hepatitis B

Treatment is not directly indicated for patients with Hepatitis B

Standard PrecautionsImmunizations

Hepatitis C

Description > 85% develop chronic form > 4 million in U.S. and 180 million worldwide affected

Etiology RNA virus, transmitted through blood Transmitted via infected blood Most common in those persons who use IV illicit drugs

or have multiple sexual partners

Hepatitis C

Signs and Symptoms Usually mild Reduction in appetite, abdominal pain, tenderness

over liver region Muscle and joint pain Jaundice, cirrhosis

Treatment Prevention Medications for progressive forms Possible liver transplant if severe


For Hepatitis C

Treatment is indicated for associated arthritis and fibromyalgia, which result in functional deficits, and is focused on improving function, increasing joint mobility, strengthening, endurance, and education on energy conservation techniques.

THE PTA MAY WORK WITH PEOPLE WITH HIV OR AIDS IN VARIOUS SETTINGS, WITH

SOME PATIENTS IN THE END STAGES OF THE DISEASE. A CLEAR KNOWLEDGE OF

THE DISEASE IS NECESSARY TO UNDERSTAND APPROPRIATE PRECAUTIONS

AND MYTHS AB OUT THE DISORDER.

Why does the PTA need to know about HIV / AIDS?

HIV/AIDS

Description HIV = human immunodeficiency virus

Sexually transmitted viral disease

AIDS = acquired immune deficiency syndrome Failure of body to develop antibodies to infecting organisms

Worldwide deaths = 25 million

Worldwide people living with the disease = 33.4 million

Most affected in Africa and Asia; 2/3 of all people with AIDS live in sub-Saharan Africa

Homosexual and bisexual men; African American men and women

AIDS

Etiology Blood-borne pathogen; several viruses exist, including HIV 1

and 2

May remain undetectable in the blood and person may / may not show symptoms for prolonged time

Body fails to develop antibodies (vs. attacking its own cells) -> susceptible to opportunistic infections -> body does not recognize or defend itself -> infections become life threatening

RNA retrovirus, attaches to CD4 receptor of T-lymphocytes; requires reverse transcriptase to multiply

AIDS

Rate of disease progression = rate that the virus attacks more T-lymphocytes

Transmitted through blood and bodily fluids Sexually Shared hypodermic needles Blood transfusions in early 1980s

AIDS

Signs and Symptoms Flu-like initially

Long-term Weight loss, chronic diarrhea Chronic fatigue, generalized progressive weakness Joint arthritis AIDS dementia complex Neurological symptoms

Secondary / opportunistic infections

AIDS

Treatment Pharmacology

“soup” or “cocktail” HAART – highly active antiretroviral therapy to improve

T-cell count, suppress HIV replication, reduces incidence of opportunistic infections


For HIV / AIDS

Treatment is indicated for muscle weakness and atrophy, fatigue, peripheral neuropathy, coordination problems, and AIDS dementia complex. Education of the patient and care providers includes transfer and ambulation training, as well as any assistance required for daily living activities.

Patients often benefit from physical touch, as they are often isolated.

Diagnosis of HIV / AIDS must be kept confidential for privacy reasons.

T H E S E D I S E A S E S A R E S E E N F R E Q U E N T LY I N T H E G E N E R A L P O P U L AT I O N, A N D M AY B E S E E N I N P H Y S I C A L T H E R A P Y F O R A S S O C I AT E D J O I N T,

M U S C L E , A N D M O B I L I T Y P R O B L E M S . I T I S I M P O R TA N T T O U N D E R S TA N D T H E T R A N S M I S S I O N O F T H E S E D I S E A S E S T H R O U G H B L O O D A N D B O D Y F LU I D

C O N TA C T, A N D T H E I M P O R TA N C E O F S TA N D A R D P R E C A U T I O N S T O P R E V E N T T H E S P R E A D O F D I S E A S E .

Why does the PTA need to know about sexually transmitted

diseases?

Cytomegalovirus

Description CMV Most common congenital virus in U.S.; 1 in 150

infants affected, 1 in 5 develop permanent disability Related to herpes viruses

Etiology Present in all body fluids, transmission through close

contact with infected fluids May be passed to fetus through pregnancy or breast

milk

Cytomegalovirus

Signs and Symptoms May or may not be present; may mimic influenza Newborn symptoms: low birth weight, microcephaly,

respiratory problems mental and motor delays, seizures,

In immunocompromised: colitis, pulmonary infections, encephalitis, neuropathy, retinitis

Organ transplant patientsTreatment

Infants treated with antiviral medication to prevent hearing loss

Antiviral medications for complications


For Cytomegalovirus

Physical therapy is not directly indicated for CMV, but it is extremely important to follow Standard Precautions, with particular attention paid to hand washing and glove wearing.

It is often highly recommended that PTs, PTAs, and all other health care workers who are or might be pregnant do not work with patients with CMV, as the virus could possibly be spread to the fetus.

Syphilis

Description Sexually transmitted bacterial disease 36,000 diagnosed in U.S. in 2006 Congenital syphilis; women 20 – 24 years of age; men =

35 – 39 years of age

Etiology Bacteria Treponema pallidum Spread through sexual contact with chancre (open sore) Indirect contact with contaminated surfaces Incubation period of 3 weeks; transmitted to fetus after

10th week of pregnancy

Syphilis

Signs and Symptoms Primary stage: infectious, small, painless chancres on genitalia,

anus, lips, mouth; heals without treatment

Secondary stage: infectious, red-brown rash on soles of feet and palms; fever, sore throat, headaches and muscle aches, weight and hair loss, fatigue

Tertiary or late-stage: affects internal organs Tabes dorsalis (progressive locomotor ataxia), syphilitic spinal

sclerosis – infection of spinal cord Sensory nerve axons destroyed Dementia, incoordination (ataxic gait); paralysis, weakness,

numbness, blindness, deafness, severe pain, death Syphilitic arthritis

Syphilis

Treatment Penicillin by intramuscular injection Regular screening Education on avoiding at risk behaviors and condom

use to avoid spreading the disease


For Syphilis

Physical therapy is not directly indicated for the primary and secondary stages, but may be needed in the late stage for neurological or musculoskeletal manifestations of the disease.

NOSOCOMIAL INFECTIONS ARE COMMONLY FOUND IN HOSPITALS AS WELL AS EXTENDED

CARE FACILITIES. KNOWLEDGE OF THESE INFECTIONS IS CRITICAL TO UNDERSTANDING THE PRECAUTIONS NECESSARY IN ORDER TO PREVENT THE SPREAD OF THE INFECTION TO

OTHER PATIENTS OR TO HIMSELF.

Why does the PTA need to know about nosocomial infections?

Nosocomial Infections

Description Hospital – acquired, health care-associated

5 infections / 1,000 patient days in the hospital

Result in 26,250 deaths per year; focus on decreasing length of hospital stays


Etiology Caused by viruses, bacteria, and fungi

Most common agents are Streptococci, Staphylococcus aureus, Enterococci, Pseudomonas, Escherichia coli, and Enterobacter species

Intensive care units

Risk increases with invasive procedures ( IV lines, catheters, intubation)


Etiology Risk factors in 3 groups:

Patient-related: seriousness of illness, whether the immune system is compromised, and length of stay needed

Organizational: contamination of air-conditioning or water systems, how close together patient beds are placed, and nurse-to-patient ratio

Iatrogenic: associated with pathogens on hands of health care team


Signs and Symptoms Develop a fever while in hospital Related to invasive procedure performed Fever, skin rash, fatigue, tachycardia

Treatment Broad spectrum antibiotic until exact cause is known Antibacterial, antiviral, antifungal medications Removal of catheters or lines thought to be the source Prevention; handwashing


For Nosocomial Infections

Physical therapist assistants are responsible for preventing the spread of infections through following standard precautions and meticulous hand-washing after patient contact and / or handling any lines.

A PTA MAY ENCOUNTER THESE DISEASES B OTH IN THE U.S. AND WHEN TRAVELING AROUND THE WORLD. IS IMPORTANT TO

KNOW HOW TO PREVENT THE DISEASES IN THEMSELVES, AS WELL AS RECOGNIZING

S IGNS AND SYMPTOMS IN PATIENTS THEY TREAT THAT MAY HAVE THESE INFECTIONS.

Why does the PTA need to know about vector- and animal-borne

infectious diseases?

West Nile Virus

Description Also West Nile Encephalitis Affects humans, mammals, birds First noted in Uganda, has spread to several parts of

the world In 2007 = 3630 cases, 124 fatalities

Etiology Birds are reservoirs for the virus -> bitten by

mosquito -> mosquito picks up live virus -> transmitted to humans and other animals via mosquito bite

West Nile Virus

Signs and Symptoms Only seen in 20% of infected people, usually mild Fever, headache, swollen lymph nodes, skin rash, eye

pain Can be neurological involvement, developing

encephalitis or meningitis

Treatment Prevention of mosquito bites Gloves when handling dead animals and birds No vaccination available


For West Nile Virus

Physical therapy may be indicated during more advanced stages of the disease as problems arise with mental and physical abilities. The patient’s physical functioning may be impacted.

WORKING IN HEALTH CARE, THE PTA WILL BE EXPOSED TO MANY OF THESE DISEASES. IMMUNITY TO THESE

DISEASES WILL PROTECT THE PTA.

Why does the PTA need to know about infectious disease immunity?

Preventable Infectious Diseases for Which Health Care Workers are Required to Have Immunity

Diphtheria Corynebacterium diphtheriae bacteria

Mumps Paramyxovirus

Pertussis (whooping cough) Bacteria Bordetella pertussis or Bordetella

parapertussis


Poliomyelitis and post-polio syndrome Virus

Rubella (German measles) Virus

Rubeola (measles) Single-strand RNA Morbillivirus


Tetanus Bacteria Clostridium tetani

Varicella (chicken pox – children, shingles - adults) Herpes zoster virus

OTHER INFECTIONS ARE COMMONLY SEEN IN HEALTH CARE, AND THE PTA WILL NEED

TO UNDERSTAND THE PRECAUTIONS RELATED TO THE DISEASES. IN ADDITION,

THE PTA NEEDS TO BE AWARE OF THE DISEASES THAT MAY BE INVOLVED IN A

TERRORIST ATTACK.

Why does the PTA need to know about other infectious diseases?

Botulism

Description Food poisoning In U.S, 145 people / year diagnosed; infants

Etiology Clostridium botulinum in bottled or canned foods Bacterial spores produce toxins which prevent

acetylcholine release -> paralysis

Botulism

Signs and Symptoms Usually symptoms w/in 36 hours, but can be up to 10

days Abdominal cramping, double vision, dry mouth,

nausea, respiratory problems, vomiting dysphagia, dysphasia, weakness, paralysis

Neurological symptoms up to 1 year

Treatment Botulinus antitoxin; antimicrobial medications

ineffective Mechanical ventilation, IV fluids, feeding tube


For Botulism

Physical therapy may be indicated for respiratory therapy during the acute phase, and for neurological rehabilitation, weakness, and paralysis if necessary during recovery.

Influenza

Description Affects upper respiratory tract Influenza viruses A and B Between 5% - 20% of the U.S. population annually;

with approx. 36,000 deaths Older adults, young children, people with other

diseases are at greatest risk Types change frequently -> immunizations do not

affect all strains Viral pneumonia from influenza can cause secondary

bacterial infection

Influenza

Etiology Spread through droplets by coughing, sneezing; through

direct contact with eyes and mouth

Signs and Symptoms From mild to severe Cough, high fever, sore throat, dyspnea, muscle aches,

headache, diarrhea, vomiting

Treatment Prevention through vaccine Rest, fluids, avoid alcohol and smoking


For Influenza

It is important for all health care workers to be vaccinated against influenza, to avoid posing a risk of infection for susceptible populations.

Chest PT may be indicated if pneumonia has developed.

Meningitis

Description Inflammation of meninges in brain and spinal cord Most common in people under age 30 Indemic in parts of Africa and India

Etiology Viruses (enteroviruses), bacteria (cryptococcal,

Escherichia coli, meningococcal, pneumococcal, staphylococcal, streptococcal, syphilitic and tuberculous

Meningitis

Signs and Symptoms Viral meningitis milder, up to 2 weeks Bacterial meningits sudden, more severe Fever, nausea, vomiting light sensitivity, headaches,

meningismus, altered levels of consciousness, seizures, tachypnea, agitation, opisthotonus, decreased appetite

Treatment Prevention through vaccination Antibacterial medications; no medications for viral type Hospitalization, IV fluids, antiseizure medications


For Meningitis

PTAs may treat patients with meningitis who have suffered neurological deficits, with treatment focused on functional rehabilitation, activities of daily living, and prevention of deformities.

Questions

infectious diseases pta 120 pathophysiology day 16

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