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INFECTIOUS DISEASES

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Management of sinusitis includes antibiotics (as appropriate),

decongestants or expectorants, and nasal corticosteroids.23

Clinical Tip

Despite the benign nature of rhinitis and sinusitis, the

manifestations (especially nasal drainage and sinus pain)

of these infections can be very disturbing to the patient

and therapist during the therapy session and may even

lower the tolerance of the patient for a given activity. The

therapist should be sympathetic to the patient's symptoms

and adjust the activity accordingly.

Influenza

Influenza (the flu) is caused by any of the influenza viruses (A, S, or C

and their mutagenic strains) that are transmitted by aerosolized

mucous droplets. These viruses have the ability to change over time

and are the reason why a great number of patients are at risk for

developing this infection. Influenza B is the mOst likely virus to cause

an outbreak within a community.

Clinical manifestations of influenza include (I) a severe cough,

(2) abrupt onset of fever and chills, (3) headache, (4) backache, (5) myalgia, (6) prostration (exhaustion), (7) coryza (nasal inflammation with profuse discharge), and (8) mild sore throat. Gastrointestinal

signs and symptoms of nausea, vomiting, abdominal pain, and diarrhea can also present in certain cases. The disease is usually selflimiting in uncomplicated cases, with symptoms resolving in 7-10

days. A complication of influenza infection is pneumonia, especially

in the elderly and chronically diseased individuals.I.'.I2.23

If management of influenza is necessary, it may consist of the

following 1.2.12.23:

• Anti-infective agents

• Antipyretic agents

• Adrenergic agents

• Antitussive agents

• Active immunization by vaccines

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AClJfE CARE HANDBOOK FOR I'HYSICAL TI-IERAPISTS

• Supportive care with I.V. fluids and supplemental oxygen, as

needed

Clinical Tip

Health care workers should be vaccinated against the

influenza virus to decrease the risk of transmission.

Pertussis

Pertussis, or whooping cough, is an acute bacterial infection of the

mucouS membranes of the tracheobronchial tree. It occurs mOst commonly in children younger than 1 year of age and in children and adults of lower socioeconomic populations. The defining characteristics are

violent cough spasms that end with an inspiratory "whoop," followed

by the expulsion of clear tenacious secretions. Symptoms may last 1-2

months. Pertussis is transmitted through airborne particles.

Management of pertussis may consist of any of the followingl':

• Anti-infective and anti-inflammatory medications

• Bronchopulmonary hygiene with endotracheal suctioning,

as needed

•

Supplemental oxygen, assisted ventilation, or both

• Fluid and electrolyte replacement

• Respiratory isolation for 3 weeks after the onset of coughing

spasms or 7 days after antimicrobial therapy

Lower Respiratory Tract Itlfections

Tuberculosis

TB is a chronic pulmonary and extra pulmonary infectious disease

caused by the tubercle bacillus. It is transmitted through airborne

Mycobacterium tuberculosis particles, which are expelled into the air

when an individual with pulmonary or laryngeal TB coughs or

sneezes." When M. tuberculosis reaches the alveolar surface of a new

host, it is attacked by macro phages, and one of two outcomes can

result: Macrophages kill the particles, terminating the infection, or

INFECTIOUS DISEASES

621

the particles multiply within the WBCs, eventually causing them to

burst. This cycle is then repeated for anywhere between 2 and 12

weeks, after which time the individual is considered to be infected

with TB and will test positive on tuberculin skin tests, such as the

Mamoux test, which uses tuberculin purified protein derivative, It or

the multiple puncture test, which uses tuberculin. At this point, the

infection emers a latem period (most common) or develops imo active

TB.24,25

A six-category classification system has been devised by the American Thoracic Society and the Centers for Disease Control and Prevention (CDC) to describe the TB status of an individual'4.26: I.

No TB exposure, not infected

2.

TB exposure, no evidence of infection

3.

Latent TB infection, no disease

4.

TB, clinically active

5.

TB, not clinically active

6.

TB suspect (diagnosis pending)

Populations at high risk for acquiring TB include (1) the elderly;

(2) Native Americans, Eskimos, and blacks (in particular if they are

homeless or economically disadvantaged); (3) incarcerated individuals; (4) immigrants from Southeast Asia, Ethiopia, Mexico, and Latin America; (5) malnourished individuals; (6) infants and children

younger than 5 years of age; (7) those with decreased immunity (e.g.,

from AIDS or leukemia, or after chemotherapy); (8) those with diabetes mellitus, end-stage renal disease, or both; (9) those with silicosis; and ( 10) those in close contact with individuals with active TB.3,24

Persons with normal immune function do nOt normally develop

active TB after acquisition and are, therefore, not considered contagious. Risk factors for the development of active TB after infection include age (children younger than 8 years and adolescents are at

greatest risk), low weight, and immunosupression.27

*A person who has been exposed to the tubercle bacillus will demonstrate a

raised and reddened area 2 - 3 days after being injected with the protein deriv-

ative of the bacilli.

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AClTTE CARE HANDBOOK I;OR PHYSICAL THERAPISTS

When anive TB does develop, its associated signs and symptoms

include (1) fever, (2) an initial nonproductive cough, (3) mucopurulent

secretions that present later, and (4) hemoptysis, dyspnea at rest or with

exertion, adventitious breath sounds at lung apices, pleuritic chest pain,

hoarseness, and dysphagia, all of which may occur in the later stages.

Chest films also show abnormalities, such as atelectasis or cavitation

involving the apical and posterior segments of the right upper lobe, the

apical-posterior segment of the left upper lobe, or both.2'

Extrapulmonary TB occurs with less frequency than pulmonary TB

but affects up to 70% of human immunodeficiency virus (HIV)-positive individuals diagnosed with TB.2' Organs affected include the meninges, brain, blood vessels, kidneys, bones, joints, larynx, skin,

intestines, lymph nodes, peritoneum, and eyes. When multiple organ

systems are affected, the term disseminated, or miliary, TB is used.2s

Signs and symptoms that manifest are dependent on the particular

organ system or systems involved.

Because of the high prevalence of TB in HrV-positive individuals

(up to 60% in some states)," it should be noted that the areas of

involvement and clinical features of the disease in this population differ from those normally seen, particularly in cases of advanced immunosllppression. Brain abscesses, lymph node involvement, lower lung involvement, pericarditis, gastric TB, and scrotal TB are all 1110re

common in HrV-positive individuals. HIV also increases the likelihood that TB infection will progress to active TB by impairing the body's ability to suppress new and latent infections.2'