Infectious Disease and Substance abuse

Question 1

Pseudomonas Definition and etiology

Answer 1

bacterium that is commonly found. Can become (And is 1 of the most aggressive stains for human bacterial infections) aggressive and abundant due to its ability to adapt and become antibiotic resistant.

Etiology: harmless to healthy Pts, extremely harmful to an individual that is immunosuppressed. Commonly found in hospital and nursing home settings. Transmitted through contact. thrives on moist surfaces therefore, swimming pools, sinks, medical equipment, and certain body parts.

Question 2

Pseudomonas Risk Factors and Gender and Age Preference

Answer 2

Risk fxs: Individuals with burns, urinary catheterization, cystic fibrosis, chronic lung diseases, chemotherapy associated neutropenia, and diabetes, mechanical ventilation. Prior hospitalization and being on antibiotics prior to current hospitalization

Men> women

Premature infants and aging adults (can lead to sepsis)

Question 3

Pseudomonas Clinical Presentation: Signs/symptoms

Answer 3

depend on the site of the infection.
Small arteries and veins
Thrombus and hemorrhagic necrosis of vessel tissues (lungs and skin)

**Respiratory tract **
(Pneumonia) dyspnea, fever, productive cough, low oxygenation, high WBC count, delirium

CNS (meninges)Fever, headache, stiff neck, nausea, and confusion
Skin and mucus membranes
Wound that is hemorrhagic and necrotic

Burn wound may appear blue or green

Bones and joints
Pain and swelling with recent puncture of skin

Spine.
Local tenderness and decrease ROM of spineMild neurologic effects

Ear(swimmers’ ear) pain and pressure.Diagnostic

Question 4

Pseudomonas Diagnostic tests

Answer 4

Dx based on lab analysis of: 
wound exudate, 
sputum from a productive cough, 
urine
blood
spinal fluid

Question 5

Pseudomonas Medical Manament

Answer 5

antibiotic therapy- affected areas may be rinsed, if lungs are affected inhalation could be mode of delivery , Debridement and draining, excision of infected areas

Question 6

Strep Definition and etiology

Answer 6

Throat infection (strep throat) which comes from streptococcus pyogenes which may also cause scarlet fever, impetigo, strep gangrene, pneumonia and others.

group A-beta hemolytic streptococcal infectionsTransmitted through person-to-person contact from respiratory droplets and through water or food. The incubation period is anywhere from two to four days

Question 7

Strep Risk Factors and Gender and Age Preference

Answer 7

5-12 are more at risk
Adults with infected children, or who work at school/ daycare.
No gender preference, not as common in summer months

Question 8

Strep Clinical Presentation: Signs/symptoms

Answer 8

100.4°F (38°C), tonsillar exudate,”10 absence of cough, mild or severe swallowing pain with a sore throat or dysphagia, a red colored pharynx, lymphadenopathy, fatigue, weakness, chills, headache, and abdominal pain

Question 9

Strep Diagnostic tests

Answer 9

throat culture -gold standard

rapid antigen detection testing (RADT) -considers S/S and age to have score

Question 10

Strep Medical Manament

Answer 10

Antibiotics: penicillin, amoxicillin, and erythromycin.

a tonsillectomy is executed for patients with recurrent streptococcal pharyngitis

Question 11

Strep Physical Therapy Tests and Measures and Implications for Strep

Answer 11

Functional strength, 5x STS - for weakness
6MWT- fatigue
Fatigue severity scale questionnaire

Question 12

Strep Best Pt practice

Answer 12

Keep up hygiene procedures, clean surfaces with (0.1%) chlorine

• exercise during an ongoing viral or bacterial infection worsens symptoms and enhances the risk for complications
• Improve VC endurance with step, or gait training to return to baseline

Question 13

Physical Therapy Tests and Measures and Implications for Pseudomonas

Answer 13

Test/Measures-
Wound healing outcome measures
All components of wound exam
Vascular screen with ABI-ROM assessment
MMT assessments

Lungs:
O2 saturation
Chest wall expansion/mobility
Cough function (productiveness)
Balance (BERG, BEST, DGI)-Strength (5xSTS)
Mobility (TUG)
Endurance (6MWT, 2MWT)
Lung auscultation

Question 14

Pseudomonas Best Pt practice

Answer 14

Wound Intervention/Treatment
Irrigation and debridement
Antiseptics
Negative pressure wound therapy- to decrease bacteria #
Moist wound healing (NPWT is more effective to removing drainage which is essential for preserving underlying tissue)
Silver dressings + antimicrobial + non occlusive
Light aerobic exercise

Lung Intervention/Treatment
Oscillating positive pressure device
Airway clearance exercises (Active cycle breathing with Huff cough)
Aerobic Exercise

Pnemonia
aerobic exercise inhibits colonization and decreases inflammation in the lungs in order to increase O2 perfusion and decrease dyspnea. Introduce resistance training bc most ADLs are a form of RT and improving strength and efficiency of mus of peripheral mus will help decreases lung demand. Also include airway clearance techniques

Prevention: dirty nails and equipment harbor bacteria, keep area clean

Question 15

Staph Definition and etiology

Answer 15

S.aureus, is a gram positive bacteria is part of the normal flora found on skin and mucus membranes, harmless bc the bacteria does not have a way to penetrate the barrier, until the surface is interrupted.
etiology: Once the bacteria is introduced into the body via a broken skin/membrane barrier, host deffenses will try to fight off membrane destroying enzymes that bacteria produces. The bacteria may evade host response and enter the blood stream, joints, other membranes ect

Question 16

Staph Risk Factors and Gender and Age Preference

Answer 16

all people who live in close quarters; military personnel, jail inmates, athletes, children at daycare. Pts admitted in hospitals; indwelling cathertars, surgical, burn ect HIV, injection drug users, hemodialysis patients, homosexual men, and healthcare workers

Question 17

Staph Clinical Presentation: Signs/symptoms

Answer 17

Soft tissue skin rxns- abscess formation, Pneumonia, may present with mild fever, pain, and slightlyelevated leukocytosis with a subtle course of illness, may present as food poisoning. Staph associated skin infections include cellulitis, furuncles and carbuncles, and small macules that sometimes develop into pus-filled abscesses

Question 18

Staph Diagnostic tests

Answer 18

Gram stain and culture of the organism from the blood, infected site, or other fluid is the main diagnostic test
An antibiotic sensitivity test determines which AB will fight the best
PCR-based assays or 2 hours blood assays allow for test tx, that is within hours not days

Question 19

Staph Med Mgmt

Answer 19

minor soft tissue and skin infections: oral medications such as trimethoprim-sulfamethozole and tetracyclines

<5cm draining and removal of abscess is enough
intravenous antibiotic treatment(typically vancomycin) for more severe infections

Question 20

Staph Physical Therapy Tests and Measures and Implications

Answer 20

Proper hand hygiene - use antimicrobial soap

Question 21

Staph Best PT practices

Answer 21

Monitor for looking for red streaks, poorly defined borders, increase in temperature, disproportionate edema, increased pain, disproportionate, thick, purulent drainage or symptoms of the patient feeling sick.
Educate on hand hygiene, patient and caregivers about the ability of the bacteria to spread to others, dont D/C or got to PT if inpatient setting till WBC is managed

Question 22

Herpes Definition and etiology

Answer 22

Infects through mucocutaneous exasperation, organ damage, and neurological deficits, with 8 different forms that are all morphologically the same with distinct epidemiologic features - each are active for a lifetime and have “flarups”
Type 1- HSV 1 Oral herpes
Type 2- HSV 2Genital herpes - can have herpes shedding
Type 3 - Varicella-zoster virus (VZV) Causes varicella/ chickenpox, reactivation causes shingles Epstein-Barr Infectious mononucleosis virus (EBV)
Type 4- Mononucleosis also known as kissing disease
Type 5- (CMV) Cytomegalovirus Commonly transmitted to embryo
6 HHV- Roseola Type Normally occurs in infants followed by high fever and rash
Type 7- Serologically associated with roseola Normally occurs in infants followed by high fever and rash
Type 8 sarcoma- Kaposi sarcoma Form of cancer typically affecting the immunosuppressed ex.HIV

Etiology: initial contraction of HSV- virus multiplies locally at mucocutaneous junction manifesting in blood and peripheral sensory neurons, then, translating through axons residing latent at the CNS ganglia.

Question 23

Herpes Risk Factors and Gender and Age Preference

Answer 23

Unprotected sex  
  -Kissing multiple people
-sex with multiple partners
 -Sharing drinks or oral objects
-a partner who has HHV 
-Immunosuppressed people
-Homosexual male intercourse 
-Women are more likely to contract the virus
Females> males for HSV 1 & 2
Risk increases as age increases;

Question 24

Herpes Clinical Presentation: Signs/symptoms

Answer 24

HSV-1
Most common sign = cold sore/blister around the lips, May have lesions in or around the mouth followed by sore throat. most commonly contracted by children leading to gingivostomatitis which causes painful sores around the mouth, fever, and swelling.
HSV-2
Grouped blisters, burning, itching, and tingling around the genitals, and malaise. may experience headaches, nausea, seizures associated with meningitis or encephalitis.

Question 25

Herpes Diagnostic tests

Answer 25

Polymerase Chain Reaction (PCR) - amplified DNA of virus for studying
Viral culture - sample collected from leison
Blood Test: less chosen out of fear of false positive, ma be selected opon request

Question 26

Herpes Med Mgmt

Answer 26

Famciclovir - treat recurrent mucocutaneous lesions, Acyclovir- neurologic problems
Penciclovir helps treat cold sore from type 1

Question 27

Herpes Physical Therapy Tests and Measures and Implications

Answer 27

possibility for Encephalitis should be monitored 2/2 high death rate s/s such as headaches, fevers, and confusion should be monitored closely and Montreal Cognitive Assessment b given.

possibility for meningitis,- monitor 4 signs of stiff neck by doing a cervical range of motion test, or light sensitivity by completing cranial nerve exam

NPRS to rate outbreaks; keep track of the effectiveness of medical tx
Depression screen

Question 28

Herpes Best PT practices

Answer 28

Moderate intensity exercise has been shown to boost the immune system. educate pt. clinician transmission is loe.

Question 29

C-diff Definition and etiology

Answer 29

Common bacteriumin the environment, releases toxins A & B, which cause intestinal cell inflammation.

etiology: two prerequisites must occur: Normal flora in GI tract must be depleted and bacteria has to be ingested. Spores are stimulated to germinate by bile salts, and latch on the epithelial cells, and release toxins.

Question 30

C-diff Risk Factors and Gender and Age Preference.

Answer 30

65 and older), antibiotic use, a serious underlying illness or weakened immune system, a previous CDI, recent hospitalizations, or residence in a long-term care facility., any other facotrs that would deplete/ disrupt intestinal mucosa. No gender preference

Question 31

C-diff Clinical Presentation: Signs/symptoms

Answer 31

watery diarrhea, abdominal cramping and tenderness.
- diarrhea occurs three times per day for two days. severe cases: patients can also present with fever, ileus, sepsis, toxic megacolon, perforation, and an elevated white blood cell count.

Question 32

C-diff Diagnostic tests

Answer 32

stool culture for ID of toxogenic isolate. In difficult to dx cases, CT to view thickening of the abdomin and colonoscopy can be done

Question 33

C-diff Med Mgmt

Answer 33

immediately discontinue antibiotic medication and to administer metronidazole (flagyl) or take vancomyocin, no gold standard treatment. Fecal transplant is possible, recurrent rate is 45%

Question 34

C-diff Physical Therapy Tests and Measures and Implications and best PT practices

Answer 34

alcohol-based hand rubs are not able to kill C. diff spores, use bleach or vaporized hydrogen peroxide. Use proper hygiene prodocols; gowns, eyemasks, dispose of soiled lined, clean surfaces ect. Determine if incontinence or gait speed is the issue of not making it to the bathroom. If issue to speed, 10 MWT can be used, and sit to stand for strength exercise.