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.

Cat Scratch Disease


Related Terms

  • Cat Scratch Bartonellosis
  • CDS

Differential Diagnosis

Specialists

  • Family Physician
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • HIV/AIDS

Factors Influencing Duration

Age and immune status will influence the length of disability.

Medical Codes

ICD-9-CM:
078.3 - Diseases Due to Viruses and Chlamydiae, Other; Cat Scratch Disease; Benign Lymphoreticulosis (of Inoculation); Cat-Scratch Fever

Overview

Cat scratch disease is an infection transmitted to humans from cats by a scratch, a bite, or exposure to cat saliva. It is caused by the bacterium Bartonella henselae, which is thought to be carried from animal to animal by fleas.

Usually the cat is a kitten or young cat and will have no evidence of illness. Rarely, the individual affected will not have exposure to cats but will become infected from scratches from a dog, monkey, other animal, or from a puncture wound from a thorn, needle, or splinter.

The incubation period for cat scratch disease is 3 to 12 days after the initial bite or scratch, at which time a localized skin reaction (pustules or papules) occurs at the site of the wound (Schraga). Within 1 to 3 weeks, lymph nodes near the lesion swell and become painful (regional lymphadenopathy), and the individual may experience mild fever, fatigue, malaise, nausea, and headache (Schraga). In most cases, the infection is self-limiting and resolves within 2 to 4 months with no residual effects (Schraga).

Incidence and Prevalence: An estimated 22,000 cases of cat scratch disease occur each year, although many may go unrecognized (Schraga). There are approximately 9.3 cases per 100,000 people, and about 2,000 individuals are admitted to US hospitals annually with a diagnosis of cat scratch disease (Schraga).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The male-to-female ratio of affected individuals is 3 to 2. In 80% to 90% of cases, individuals who develop cat scratch disease are younger than age 21 (Schraga). In temperate climates, cat scratch disease is most common during the fall and early winter; in warmer climates, it is most common during the summer (Mankekar). Individuals with cats younger than 1 year of age are 15 times more likely to contract cat scratch disease than owners of older cats (Friedman).

Individuals who have HIV infection or are undergoing immunosuppressive therapy have a higher risk of developing systemic symptoms (disseminated disease). However, neither form of the infection is life threatening.

Source: Medical Disability Advisor



Diagnosis

History: An estimated 90% of individuals report an exposure to cats, although exposure to squirrels, dogs, crab claws, monkeys, pins, thorns, splinters, or barbed wire also may cause this disease (Mankekar, Schraga). Usually, the individual will notice a primary lesion within 3 to 10 days. One to 3 weeks later, the individual may report symptoms of a generalized infection, with regional lymph node enlargement in 90% of cases (Schraga). About 80% of individuals report a swollen lymph node in the head, neck, armpit (axilla), or upper limb (Mankekar). The individual may experience low-grade fever (30% to 50% of cases), fatigue and malaise (30% of cases), headache, loss of appetite (anorexia), or nausea (13% of cases) (Mankekar).

Physical exam: The exam may reveal an infected, scabbed lesion or a small, circular, solid elevation of the skin with a central pus-filled region. Lesions typically are 0.5 cm or smaller (Friedman). The lymph nodes are swollen and become filled with pus, draining spontaneously in 25% to 30% of cases (Schraga). The spleen may be enlarged. Rashes of variable appearance may be seen.

Tests: Until recently, cases of cat scratch disease often went undiagnosed due to the difficulty in testing. However, the Bartonella henselae indirect fluorescent antibody (IFA) test has proved to be highly accurate for the detection of infection and diagnosis of cat scratch disease. A lymph node biopsy may be helpful to rule out other causes of swollen glands. In severe cases, electroencephalogram (EEG) and cerebrospinal fluid testing may help rule out alternate diagnoses.

Source: Medical Disability Advisor



Treatment

Cat scratch disease usually resolves without therapy within 2 to 4 months (Schraga). The more severe disseminated form is treated with antibiotics. Immunocompromised individuals also may require antibiotic therapy. Medications to alleviate symptoms of pain or fever (analgesics and antipyretics) may be given, and warm compresses may be applied over painful, swollen lymph nodes to promote comfort. If a swollen lymph node fails to subside spontaneously after a few months and is painful, needle aspiration can be done to relieve pain and hasten recovery.

Because the risk of disease transmission is transient, lasting only for a period of up to 3 weeks, it is not necessary to remove the cat from the individual's household (Mankekar, Schraga). Individuals should be advised to initiate flea control and to handle pets gently to avoid receiving bites or scratches (Friedman).

Source: Medical Disability Advisor



Prognosis

The prognosis for this infection is excellent, with the majority of cases spontaneously resolving within 2 to 4 months (Schraga). Low-grade fever may last for up to 2 weeks, and lymph node enlargement typically lasts for 4 to 6 weeks (Friedman). In less than 1% of cases, individuals may develop fever and severe disseminated infection that may last for weeks; however, a full recovery is expected, even in immunocompromised individuals (Friedman).

Source: Medical Disability Advisor



Complications

Complications are rare but in 10% of cases may include prolonged fever, arthritis, synovitis, pneumonitis, Parinaud's syndrome (eye disorders), neuroretinitis, and osteomyelitis (Schraga). Encephalitis occurs in 2% to 4% of cases (Schraga). Immunocompromised individuals may develop complications that respond well to antibiotic treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work accommodations may be required while fever or severe systemic symptoms persist. These consist of permitting the individual to have reduced work duties and frequent rest breaks if fever, malaise, or fatigue occurs.

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 history of exposure to cats? Exposure to dogs or monkeys?
  • Did individual sustain a animal scratch or bite? Puncture wound from a thorn, needle, or splinter?
  • On exam, was an infected, scabbed ulcer or a small, circular, solid elevation of the skin with a central pus-filled region present?
  • Are lymph nodes swollen and filled with pus? Do they occasionally drain spontaneously?
  • Are rashes of variable appearance seen?
  • Was a Bartonella henselae IFA test done to confirm diagnosis?
  • In uncertain cases, was a lymph node biopsy used to confirm the diagnosis?
  • In severe cases, was electroencephalogram (EEG) or cerebral spinal fluid testing necessary to rule out alternate diagnoses?

Regarding treatment:

  • If symptoms are not resolving, is the infection widespread or is individual immunocompromised? Is antibiotic therapy warranted?
  • Is medication to relieve fever or pain necessary?
  • Is individual using warm compresses over painful lymph nodes to promote comfort?
  • If a painful, swollen lymph node fails to subside after a few months, would needle aspiration of the node help relieve pain and hasten recovery?

Regarding prognosis:

  • Have symptoms persisted beyond expected duration?
  • Does diagnosis need to be revisited?
  • Has individual experienced complications related to the illness, such as with visual changes, encephalitis, or joint pain?
  • Does individual have an underlying condition that may affect recovery?
  • Would individual benefit from evaluation by an infectious disease specialist?

Source: Medical Disability Advisor



References

Cited

Friedman, Allan D. "Catscracth Disease." eMedicine. Eds. Itzhak Brook, et al. 28 May. 2009. Medscape. 24 Sep. 2009 <http://emedicine.medscape.com/article/962445-overview>.

Mankekar, Gauri. "Catscratch Disease." eMedicine. Eds. Jack A. Coleman, et al. 22 Jul. 2009. Medscape. 24 Sep. 2009 <http://emedicine.medscape.com/article/858102-overview>.

Schraga, Erik. "Catscratch Disease." eMedicine. Eds. Jeffrey Glenn Bowman, et al. 6 Mar. 2008. Medscape. 24 Sep. 2009 <http://emedicine.medscape.com/article/781320-overview>.

Source: Medical Disability Advisor






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