Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Candidiasis


Related Terms

  • Candidosis
  • Moniliasis
  • Thrush
  • Yeast Infection

Differential Diagnosis

Specialists

  • Dermatologist
  • Gynecologist
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Addison disease
  • Blood malignancy
  • Conditions requiring indwelling catheters or artificial heart valves
  • Dental dysplasia
  • Diabetes
  • HIV/AIDS
  • Hypothyroidism
  • Organ transplant, bone marrow transplant
  • Other immune system disorders (autoimmune antibodies)
  • Polyglandular autoimmune disease
  • Thymomas

Factors Influencing Duration

The presence of serious underlying disease, immunosuppression, or the presence of candidemia, the timeliness of treatment, and response to treatment can influence the length of disability.

Medical Codes

ICD-9-CM:
112.0 - Candidiasis, Mouth; Thrush (Oral)
112.1 - Candidiasis, Vulva and Vagina; Candidal Vulvovaginitis; Monilial Vulvovaginitis
112.2 - Candidiasis, Other Urogenital Sites; Candidal Balanitis
112.3 - Candidiasis, Skin and Nails; Candidal Intertrigo; Candidal Onychia; Candidal Perionyxis [Paronychia]
112.5 - Candidiasis, Disseminated; Systemic Candidiasis
112.81 - Candidal Endocarditis
112.82 - Candidal Otitis Externa; Otomycosis in Moniliasis
112.83 - Candidal Meningitis
112.84 - Candidal Esophagitis
112.85 - Candidal Enteritis
112.89 - Candidiasis, Other Specified Sites; Other
112.9 - Candidiasis, Unspecified Site

Overview

Candidiasis is a general term describing fungal infections caused a variety of species of the genus Candida, most often by Candida albicans, a yeast-like fungus. These fungi normally are present in the mouth, vagina, and intestines of healthy individuals, and the normal bacteria in these areas keep the amount of Candida species in balance. Infection by candidal fungi, therefore, depends on the weakened immune status of the individual in order to invade tissue that normally would be resistant to infection and the opportunity to gain access to the circulatory system (opportunistic infection). Patients in hospitals and those with chronic disease are at increased risk for invasive candidiasis because they are less resistant to invasive organisms.

The most common condition is topical candidiasis (fungus growing on the surface of the body). An example of this is a common form of “diaper rash” in infants. Topical candidiasis can affect the skin, the vagina, the mouth, and in immunocompromised individuals (like HIV patients), the esophagus.

Invasive candidiasis is a serious illness in which Candida invades the blood stream and spreads internally throughout the body. This is usually seen in patients who are seriously ill with other diseases who have been receiving potent antibiotics that treat bacterial infection.

Candida infections that develop in immunocompromised individuals can affect the entire body (disseminated or systemic candidiasis) and become life threatening. Individuals who develop infections typically get them from candidal organisms already present on the body. Some individuals, however, develop infection from Candida species that live outside the human body in the environment or on inanimate objects such as on food, clothing, countertops, floors, and in air-conditioning vents.

All Candida infections are opportunistic and begin with increased colonization on the junction of mucous membrane and skin surfaces (mucocutaneous surfaces) of vulnerable parts of the body such as oral, nasal, vaginal, and anal orifices, and the lining of the respiratory tract (respiratory epithelium). Candida may be cultured (grow in the laboratory) from mucous membranes or skin without there being any illness. Thus, the presence of Candida on a culture report does not mean the individual necessarily has an illness due to Candida, unless the culture is from the blood, or a body fluid (like spinal fluid). Under certain abnormal conditions, including the reduction of normal bacteria in a given part of the body or skin (cutaneous) defects such as wounds, ulcerations, and burns, the fungi can overgrow and cause infection of the outer layers of the skin and mucous membranes. This may occur in the mouth (oral thrush), in the vagina or penis (genital candidiasis), between folds and surfaces of skin (intertrigo), and in and around the nails (paronychia and onychomycosis).


Candidal infections can involve any part of the anatomy. In some cases, the fungus enters the bloodstream and causes invasive disease affecting internal body organs such as the kidneys, spleen, lungs, liver, eyes, meninges, brain, and heart valves. This condition is called systemic or disseminated candidiasis; it can result in a range of diseases such as superficial mucocutaneous disease, candidiasis of the liver and spleen (hepatosplenic candidiasis), and peritonitis.

Incidence and Prevalence: Candida species are the most common fungi affecting humans. From 30% to 55% of young adults are found to have oropharyngeal colonization by Candida species, and 40% to 65% of fecal samples are found to contain Candida species (Hidalgo). Genital candidiasis (vulvovaginitis) is the second most common cause of vaginitis in women. Approximately 75% of women have had at least one episode (Hidalgo). More than 90% of HIV-infected individuals develop candidiasis of the mouth or throat, and 10% may then develop esophageal candidiasis (Hidalgo). In blood cultures from individuals with systemic infections, Candida species are the fourth most commonly isolated organism (Hidalgo).

In recent years, autopsies have revealed a significant increase in the incidence of systemic candidiasis; the incidence of Candida albicans in the bloodstream (candidemia) has increased, partly because more individuals are at risk because individuals with certain chronic diseases (e.g. HIV infection/AIDS, diabetes) live longer and partly because awareness of the condition has increased (Hidalgo).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals with a suppressed immune system due to cancer treatment with chemotherapy or radiation, extended use of corticosteroids, bone marrow or organ transplantation, or HIV infection/AIDS are at increased risk for developing candidiasis. Also at increased risk are those receiving broad-spectrum antibiotics or parenteral nutrition, or using intravascular devices; those who have had recent bacterial infection, burns, or severe trauma; and those who have had surgery or been hospitalized for a prolonged period regardless of the diagnosis. Chronic mucocutaneous candidiasis occurs more frequently in individuals with diabetes or other endocrine diseases such as hypoparathyroidism, hypothyroidism, or Addison disease, or with certain autoimmune diseases, with antibodies to adrenal, thyroid, or gastric tissues.

Individuals who wear dentures or who have a chronic dry mouth caused by atrophy of the saliva glands (xerostomia) and intravenous (IV) drug addicts who use dirty needles are at higher risk for Candida infection. The use of devices such as urinary catheters, respirators, or IV ports also increases susceptibility among hospitalized individuals.

If a woman is in her third trimester of pregnancy, past menopause, diabetic, or taking antibiotics, birth control pills (oral contraceptives), or corticosteroid drugs, she is more likely to develop a genital Candida (yeast) infection. Candida also can spread through intimate or sexual contact.

Source: Medical Disability Advisor



Diagnosis

History: A complete health history is needed to help diagnose Candida infection and possible underlying causes. Symptoms vary based on the location of the infection. The individual may report chronic infections affecting the skin, hair, nails, and mucous membranes of the mouth, throat, genitals, and anus. In cutaneous candidiasis, the individual may report diffuse eruptions on the skin of the trunk, chest, and extremities, with extreme itching.

Genital candidiasis in women (vulvovaginitis) results in a white vaginal discharge, swelling, redness, itching, and irritation of the genital area. Symptoms typically are more intense the week preceding the onset of menstrual bleeding. Genital candidiasis in men (balanitis) may produce a discharge from the penis.

Respiratory tract candidiasis may develop in individuals whose infection started with oropharyngeal infection. Symptoms include a sore throat, hoarseness, productive cough, and shortness of breath (dyspnea). Fever may be present.

Individuals with candidal esophagitis may report pain and possible digestive symptoms if the infection has progressed into the intestines.

Individuals with candidemia may report fever and chills and lesions on the trunk, arms, and legs. Changes in mental status or behavior may be noted. These symptoms of disseminated infection are more apt to be observed in hospitalized individuals than in those reporting symptoms in an office visit.

Physical exam: Physical findings vary depending on the location of the Candida infection and can range from minor and unremarkable to hoarseness and coughing (respiratory tract candidiasis) to fever, confusion, and coma (systemic infection). Mucocutaneous infections with Candida species are the easiest to recognize and diagnose; internal infections such as candidiasis of the kidney (renal candidiasis) and disseminated Candida infection are more complex, harder to confirm, and may only be diagnosed at autopsy.

Oral thrush appears as white or yellow curd-like patches that cover parts of the mouth and throat, usually starting with the tongue or inside the cheeks. When the patches are scraped off, the membrane is raw and bleeds. The corners of the mouth may be inflamed. Infection may spread to the rest of the mouth as well as the tonsils, throat, larynx, esophagus, and respiratory system. In the esophagus, candidiasis may cause painful ulcers that spread throughout the gastrointestinal system. Fever may be present.

Vulvovaginitis is indicated by a white cheese-like vaginal discharge, the presence of pustular lesions in the vaginal area, and redness and swelling. The cervix typically appears normal. In men, the glans penis may be reddish with small blisters or ulcers. In more severe cases, the foreskin may be swollen, causing it to tighten over the penis (phimosis).

Skin infections may appear as a generalized rash with red, slightly swollen patches that may itch and ooze. Small red blisters may surround the patches. Skin infections are most commonly found in skin folds (e.g., in the armpits, navel, groin, or buttocks), between the toes and fingers, or beneath the breasts. Candida species also may infect the scalp (folliculitis) and fingernails (paronychia and onychomycosis), especially in individuals with diabetes. Intertrigo may begin as an itchy (pruritic) rash with large pustules that can erupt and enlarge with maceration and fissures of the skin. Metastatic lesions may be found in 10% of patients with disseminated candidiasis (Hidalgo).

Fingernail infection starts with painful red inflammation that may develop pus. If infection is located beneath the fingernail, the nail may loosen and expose a noticeably white or yellow color underneath it.

Candidal musculoskeletal infections commonly affect the knees and vertebral column, and the findings may include tenderness of the site, redness (erythema), and sometimes bone deformity.

Besides examination of specific areas of irritation or infection, the physician examiner will look for signs and symptoms of immunosuppression or chronic disease that may be associated with increased risk for candidiasis.

Tests: Discharge from the vagina or penis and scrapings from a thrush-coated tongue or from a superficial skin or nail lesion can be examined under a microscope to identify yeast-like fungi. Additionally, a potassium hydroxide smear or Gram stain may demonstrate fungal cells. The diagnosis of mucocutaneous candidiasis is confirmed by culture of the scrapings or discharge. A tissue biopsy of a lesion also may be stained and examined microscopically for Candida. Blood or tissue cultures are performed to diagnose or rule out candidemia or systemic infection. Blood cultures, however, are negative in 50% of individuals with invasive infection because the fungal pathogens do not always access the bloodstream (Hidalgo). In these cases, tissue culture is necessary. After positive culture, the Candida species usually is identified by yeast-cell morphology or non-culture biochemical assays. Therapeutic decisions can be guided by antifungal susceptibility testing.

Routine laboratory tests usually are of no help in diagnosis, however, urinalysis may help diagnose renal candidiasis. Urinalysis may reveal increased white blood cells (WBC), elevated protein, and fungal cells. Urine fungal culture also may be done. In suspected candidiasis of the liver and spleen (hepatosplenic candidiasis), serum alkaline phosphatase is determined and may be elevated.

A sputum culture may reveal Candida species, and a sputum Gram stain may reveal WBCs and fungal cells if the respiratory tract is infected. Respiratory tract candidiasis often is diagnosed with direct or indirect laryngoscopy or bronchoscopy; chest x-rays may help differentiate bacterial pneumonia as a cause of fever. Candidiasis of the eyes (Candida endophthalmitis) is detected with funduscopic examination. X-rays and other imaging studies (computed tomography [CT], magnetic resonance imaging [MRI]) may be needed to investigate candidal musculoskeletal conditions such as Candida arthritis, osteomyelitis, costochondritis, or myositis. Gastrointestinal candidiasis is confirmed by endoscopy with or without biopsy. Contrast-enhanced CT may help to differentiate hepatosplenic abscess from candidiasis, peritonitis, renal abscess, or pyelonephritis.

Source: Medical Disability Advisor



Treatment

Candidiasis is treated with either topical or systemic antifungal drugs, depending on the type of infection, its location, the presence of underlying disease, and the individual's immune status. Susceptibility of the Candida species to various antifungal drugs is also a factor in determining treatment. If candidiasis is associated with another disorder such as diabetes mellitus or a blood malignancy, the underlying disease must be treated. If the infection is associated with use of antibiotics, medication typically is stopped. If infection was introduced through an indwelling catheter, intravenous device, or the use of parenteral nutrition, the invasive device is removed or changed. If an artificial heart valve is infected, it must be removed and replaced as well.

Thrush is treated with antifungal mouth rinses. Antifungal powder may be used on dentures. Topical antifungal drugs (e.g., clotrimazole, econazole, ciclopirox, miconazole, nystatin) are used for skin and fingernail infections. The skin needs to be kept dry and exposed to the air as much as possible. If fingernail infection is persistent and has caused the nail to be deformed, the nail may need to be removed. Abscesses may be drained and systemic antifungal therapy prescribed. Systemic treatment may be continued for 3 to 6 months or be taken in a staggered schedule with dosage interrupted by 3-week periods without medication (Hidalgo).

In women, vulvovaginal candidiasis is treated with an antifungal ointment or suppository placed in the vagina and sometimes a single dose of oral fluconazole. Gentian violet (also called crystal violet) solution painted directly on the affected area or boric acid suppositories placed internally also may be effective. Other predisposing factors (e.g., using oral contraceptives) may need to be re-evaluated. Some women may have recurrent episodes of vulvovaginitis that are difficult to treat. Chronic vulvovaginal candidiasis may require prophylactic antifungal therapy with an intermittent schedule of oral fluconazole for 6 months. In men, an antifungal ointment may be used or oral fluconazole given if the condition becomes chronic. If re-infection occurs, an individual's sexual partner also may need to be treated.

For systemic infections, disseminated candidiasis with end-organ candidiasis, or candidemia, intravenous or oral antifungal drugs is used. The optimum dosage and period of treatment depends on the individual's underlying diagnosis and immune status. Newer antifungal drugs may be administered for invasive candidiasis, including new formulations of amphotericin B, newer azoles, and echinocandins. Antifungal resistance is sometimes a factor in poor response to systemic therapies; in vitro susceptibility assays must be used to determine the best individual approach.

The involvement of major organ systems in candidal infections may require surgery to drain abscesses. Splenic abscesses may necessitate removal of the spleen.

Source: Medical Disability Advisor



Prognosis

Prognosis depends on the condition that precipitated candidiasis and its severity, chronicity, and treatability. Genital candidiasis typically responds to treatment within several days. Oral candidiasis (thrush) often is difficult to treat, particularly in individuals with HIV infection/AIDS or other immunocompromised status. Outcome of invasive disease depends on the extent of and site of infection. Dissemination is more likely and the outcome more serious when the individual has a progressive underlying life-threatening disease. The presence of Candida in the bloodstream (candidemia) has a mortality rate of 30% to 40% (Hidalgo). The mortality rate is lower if the infection is introduced through an invasive device rather than attributed to underlying disease.

Source: Medical Disability Advisor



Rehabilitation

Candidiasis of the skin or mucous membranes does not require rehabilitation therapy. Invasive disease may require physical therapy depending on the site and severity of infection and whether infection is chronic.

Source: Medical Disability Advisor



Complications

Complications usually occur in those who are severely debilitated or whose immune system is either deficient (HIV infection/AIDS) or suppressed (i.e., taking drugs as chemotherapy, treatment of autoimmune disease, or to prevent rejection of an organ transplant). In such individuals, candidiasis may become disseminated, which significantly complicates treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may need to avoid hot, humid environments and chemical exposures that can irritate the skin. Individuals with candidiasis affecting the nails should avoid keeping their hands in water for long periods.

Candida can be passed from person to person through hand contact in medical settings. Infection control precautions should be practiced when cross-contamination between individuals is a possibility.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a weakened immune system due to HIV infection/AIDS, treatment of cancer or autoimmune disease, or following organ transplant?
  • Does individual have an indwelling IV catheter? Artificial heart valve? Other invasive device?
  • Does individual have malignancies of the blood? Diabetes? Endocrine diseases such as hypothyroidism or Addison disease?
  • Has individual recently had surgery? Hospitalization?
  • Is individual in the third trimester of pregnancy?
  • Has individual recently taken antibiotics? Oral contraceptives? Corticosteroids?
  • Does individual have a white coating covering the tongue?
  • Does individual have chest pain, hoarseness, cough, or difficulty swallowing?
  • Does individual have a white vaginal discharge? Swelling? Redness? Itching? Irritation?
  • Is there discharge from the penis?
  • Does individual have pain in knees or vertebrae? Redness or bone deformity?
  • Does individual have fever and chills?
  • Do lesions occur on the trunk, arms, and legs?
  • Was the discharge or skin scraping examined microscopically? Stained with Gram stain?
  • Did individual have cultures of the scrapings or discharge? Blood culture?
  • Was there any evidence of disseminated fungal infection? Were imaging studies done to rule out organ system involvement?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Was individual treated with either a topical or systemic antifungal drugs?
  • If individual has an underlying disease, is it being treated? Is treatment successful?
  • If individual was on antibiotics, were they stopped?
  • Were any invasive devices removed or replaced?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that could affect ability to recover?
  • Has candidiasis spread to other parts of the body? Is this complication being treated systemically?
  • Could individual be resistant to current antifungal medication? Has in vitro susceptibility testing been done to identify a more effective treatment?

Source: Medical Disability Advisor



References

Cited

Hidalgo, Jose A., and Jose A. Vazquez. "Candidiasis." eMedicine. Eds. David H. Shepp, et al. 14 Jul. 2008. Medscape. 3 Nov. 2009 <http://emedicine.medscape.com/article/213853-overview>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.