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Management of encephalitis may consist of the followingl2,
• Anti-infective agents
• Intracranial pressure management
• Mechanical ventilation, with or without tracheostomy (as
indicated)
• Sedation
INFEcnOUS DISEASES
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• i.v. fluid and electrolyte replacement
• Nasogasrric rube feedings
Musculoskclctal lnfcctions
Osteomyelitis is an acute infection of the bone that can occur from
direct or indirect invasion by a pathogen. Direct invasion is also
referred to as exogenous or acule contagious osteomyelitis and can
occur any time there is an open wound in the body. Indirect invasion
is also referred to as endogenous or acute hematogenous osteomyelitis
and usually occurs from the spread of systemic infection. Both of
these types can potentially progress to subacute and chronic osteomyelitis. Acute osteolllyelitis typically refers to an infection of less than I month's duration, whereas chrollic osteomyelitis refers to infection
that last longer than 4 weeks' time.39.'0
Acute c01ltag;olts osteomyelitis is an extension of the concurrent
infection in adjacent soft tissues to the bony area. Trauma resulting in
compound fractures and tissue infections is a common example. Prolonged orthopedic surgery, wound drainage, and chronic illnesses, such as diabetes or alcoholism, also predispose patients to acute contagious osteomyelitis.40.41
Awte helllatogel/olls osteomyelitis is a blood-borne infection that
generally results from S. allrellS infection (80%)' and occurs mostly in
infants, children (in the metaphysis of growing long bones), or
patients undergoing long-term i.v. therapy, hyperalimentation, hemodialysis, or corticosteroid or antibiotic therapy. Patients who are malnourished, obese, or diabetic, or who have chronic joint disease, are also susceptible to acute hematogenous osteomyelitis.J9,4o
Clinical presentation of both types of acute osteomyelitis includes
(1) delayed onset of pain, (2) tenderness, (3) swelling, and (4) warmth
in the affected area. Fever is present with hemarogenous osteomyelitis. The general treatment course for acute osteomyelitis is early and aggressive admini tration of the appropriate antibiotics to prevent or
limit bone destrllction.I.JI .39,4o
Chronic osteomyelitis is an extension of the acute cases discussed
above. It results in marked bone destruction, draining sinus tracts,
pain, deformity, and the potential of limb loss. Chronic osteomyelitis
can also result from infected surgical prostheses or infected fractures.
Debridement of dense formations (sequestra) may be a necessary
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AClIrE CARE HANDBOOK FOR PHYSICAL THERAPISfS
adjunct to the antibiotic therapy. If the infection has spread to the surrounding soft tissue and skin regions, then grafting, after debridement, may be necessary. Good results have also been shown with hyperbaric oxygen therapy for chronic osteomyelitisJ9.40
Clinical Tip
Clarify weight-bearing orders with the physician when
performing gait training with patients who have any form
of osteomyelitis. Both upper and lower extremities can be
involved; therefore, choosing the appropriate assistive
device is essential to preventing pathologic fracture.
Skin Infections
Cellulitis, or erysipelas, is an infection of the dermis and the subcutaneous tissue that can remain localized or be disseminared into the bloodstream, resulting in bacteremia (rare). Cellulitis occurs most
commonly on the face, neck, and legs.
Groups A and G Streptococcus and S. aureus are the usual causative
agents for cellulitis and generally gain entry into the skin layers when
there are open wounds (surgical or ulcers). Patients who are at most
risk for developing cellulitis include those who are postsurgical and
immunocompromised from chronic diseases or medical treatment.
The primary manifestations of cellulitis are fever with an abrupt
onset of hot, stinging, and itchy skin and painful, red, thickened lesions
that have firm, raised palpable borders in the affected areas. Identifying
the causative agent is often difficult through blood cultures; therefore,
localized cultures, if possible in open wounds, may be more sensitive in
helping to delineate the appropriate antibiotic treatment.41-4J
Gastrointestinal Infections
Gastroenteritis is a global term used for the inflammation of the
digestive tract that is typically a result of infection. The primary cause
of gastroenteritis is viral infection from rota virus, adenovirus, astrovirus, calicivirus, and small round-structured viruses. Gastroenteritis can also occur from bacterial infection from E. coli, Shigella (which
causes bacterial dysentery), Clostridium difficile, and Salmollella.