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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