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Management of TB may consist of the following'·2.12,

•

Anti-infective agents

• Corticosteroids

• Surgical intervention to remove cavitary lesions (rare) and areas

of the lung with extensive disease or to correct hemoptysis, spontaneolls pneumothorax, abscesses, inrestinal obstruction, ureteral stricture, or any combination of these

• Respiratory isolation until antimicrobial therapy is initiated

• Blood and body fluid precautions if extra pulmonary disease is

present

• Skin testing (i.e., Mantoux test and multiple puncture test)

• Vaccination for prevention

INFEcnOUS DISEASES

623

In recent years, ncw strains of M. tuberculosis that are resistant to

antitubercular drugs have emerged. These 1rI"ltidrug-resistallt TB

strains arc associatcd with fatality rates as high as 890/0 and are common in HIV-infected individuals. Treatment includes the use of direct observational therapy (DOT) and direct observational therapy, shortcourse (DOTS). These programs designate health care workers to observe individuals to ensure that they take their medications for the

entire treatment regimen or for a brief period, respectively, in hopes of

minimizing resistance.2s

Clinical Tip

•

Facilities often provide specialized masks to wear

around patients on respiratory precautions for TB. The

masks are impermeable to the airborne mycobacterium.

Always verify wirh the nursing staff or physician before

working with these patients to determine which mask to

wear.

•

Patients who are suspected of, but not diagnosed with,

TB are generally placed on "rule-out TB" protocol, In

which case respiratory precautions should be observed.

Histoplasmosis

Histoplasmosis is a pulmonary and systemic infection that is caused

by infective spores (fungi), most commonly found in rhe soil of the

central and eaStern United States. Histoplasmosis is transmitted by

inhalarion of dusr from the soil or bird and bat feces. The spores form

lesions within the lung parenchyma that can be spread to other tissues. The incidence of fungal infection is rising, particularly in immunocompromiscd, immunosuppressed, and chronically debilitated indi-viduals who may also be receiving corticosteroid, antineoplastic,

and mulriple antibioric therapy."·3o

Different clinical forms of histoplasmosis are (1) acute, benign

respiratory disease, which results in flu-like illness and pneumonia;

(2) acute disseminated disease, which can result in septic-type

fever; (3) chronic disseminated disease, which involves lesions in

the bone marrow, spleen, and lungs and can result in immunodeficiency; and (4) chronic pulmonary disease, which manifests as progressive emphysema.

624

ActITE CARE HANDBOOK FOR PllYSICAl THERAPISTS

Management of histoplasmosis may consist of the following '2.19.3L

• Anti-infective agents

• Corticosteroids

• Antihistamines

• Supportive care appropriate for affected areas in the different

forms of histoplasmosis

Legionellosis

Legionellosis is commonly referred to as Legionnaire's disease and is

an acute bacterial infection primarily resulting in patchy pulmonary

infiltrate(s) and lung consolidation. However, other organs may also

become involved, especially in the immunocompromised patient.

Legionellosis is transmitted by inhalation of aerosolized organisms

from infected water sources.

Primary clinical manifestations include high fever, malaise, myalgia, headache, and nonproductive cough. Other manifestations can also include diarrhea and other gastrointestinal symptoms. The disease is rapidly progressive during the first 4-6 days of illness, with complications that may include renal failure, bacteremic shock, and

respiratory failure. I,12,J2

Management of legionellosis may consist of the following'· 12•J2 :

• Anti-infective agents

• Supplemental oxygen with or without assisted ventilation

• Temporary renal dialysis

• i.v. fluid and electrolyte replacement

Cardiac Infections

Infections of the cardiac system can involve any layer of the heart

(endocardium, myocardium, and pericardium) and generally result in

acute or chronic depression of the patient'S cardiac output. Those

infections that result in chronic cardiomyopathy most likely require

cardiac transplantation. Refer to Chapters 1 and 12 for a discussion

of cardiomyopathy and cardiac transplantation, respectively. This section focuses on rheumatic fever and resultant rheumatic heart disease.

INFE.cnOUS DISEASES 625

Acute rheumatic {ever is a clinical sequela occurring in up to 3% of

parients wirh group A �-srreprococcal infection of rhe upper respira[Ory tract. It occurs prin"larily