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.

Escherichia coli


Related Terms

  • Bacillary Dysentery
  • Diarrheogenic E. coli
  • E. coli Gastroenteritis
  • E. coli O157:H7
  • EHEC
  • EIEC
  • Enterohemorrhagic E. coli
  • Enteroinvasive E. coli
  • Enterotoxigenic E. coli
  • Enterovirulent E. coli
  • ETEC
  • Gastroenteritis
  • Hemorrhagic Colitis
  • Traveler's Diarrhea

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Hematologist
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Nephrologist

Comorbid Conditions

  • Anorexia nervosa
  • Dehydration
  • Immune system disorders
  • Infection
  • Weakness

Factors Influencing Duration

Factors that may lengthen disability include the type of infection, severity of symptoms, degree to which dehydration and electrolyte imbalance is prevented or controlled, development of complications such as HUS, age of the individual, and general health of the individual.

Medical Codes

ICD-9-CM:
008.00 - Intestinal Infections Due to Other Organisms; E. coli, Unspecified; E. coli enteritis NOS
008.01 - Intestinal Infections Due to Other Organisms; Enteropathogenic E. coli
008.02 - Intestinal Infections Due to Other Organisms; Enterotoxigenic E. coli
008.03 - Intestinal Infections Due to Other Organisms; Enteroinvasive E. coli
008.04 - Intestinal Infections Due to Other Organisms; Enterohemorrhagic E. coli
008.09 - Intestinal Infections Due to Other Organisms; E. coli Infections, Other Intestinal

Overview

Escherichia coli (E. coli) is a common type of bacteria with hundreds of strains. Typically harmless, most strains produce infection only under special circumstances, such as when they are introduced into a body site that is normally sterile. In general, E. coli causes inflammation of the small intestine, which in healthy adults is self-limiting but in children can have dire consequences, possibly even resulting in death. In other cases, depending on the body site entered, E. coli can produce a variety of infections, ranging from a routine infection of the urinary tract to a life-threatening infection of the blood (septicemia).

A number of E. coli strains are routinely harmful. They produce a mild to severe and sometimes fatal foodborne intestinal infection. Although E. coli is the most common type of bacteria in the intestine, when harmful strains gain entrance they damage the intestinal wall, either by releasing a toxin or by actually penetrating and invading the wall. The result is an intestinal infection (gastroenteritis) that causes diarrhea.

Six categories of E. coli produce diarrheal gastroenteritis. Three of them affect adults: enterohemorrhagic E. coli (EHEC, also known as Shiga toxin-producing E. coli [STEC] and verocytotoxin-producing E. coli [VTEC]), enterotoxigenic E. coli (ETEC), and enteroinvasive E. coli (EIEC). Within each of these categories, there are a variety of E. coli strains.

EHEC (STEC) is the one most often mentioned in the media today. It is referred to as E. coli O157:H7, although it is only one of a number of strains within this category. The toxin released by EHEC produces a type of bloody diarrhea known as hemorrhagic colitis. Serious and even fatal complications can also develop. EHEC originates in animals, particularly cattle and sometimes deer, and can be passed to individuals who consume undercooked meat (particularly ground beef), contaminated water, and raw milk. It can also be transmitted through apple cider, fruits, and vegetables contaminated with feces from infected animals or from other infected individuals.

ETEC commonly causes traveler's diarrhea. Like EHEC (STEC), ETEC produces symptoms through the release of a toxin. The bacteria are passed from individual to individual through food or water contaminated with the infected individual's feces.

EIEC causes a type of gastroenteritis known as bacillary dysentery (inflammatory diarrhea). It is also passed from individual to individual through contaminated food or water. Unlike EHEC (STEC) and ETEC, EIEC does not produce a toxin but rather invades the intestinal wall. It is primarily found in underdeveloped countries; only occasional cases have been reported in an industrialized country.

Incidence and Prevalence: EHEC (STEC) diarrhea occurs in North America, Europe, South Africa, Japan, and the southern portions of South America and Australia. In the US, EHEC produces approximately 265,000 cases of infection each year ("E. coli").

In adults, ETEC typically occurs when an individual from an industrialized country visits a developing country. Each year 20% to 50% of international travelers (an estimated 10 million individuals) develop traveler's diarrhea; high-risk destinations are developing countries of Latin America, Africa, Asia, and the Middle East. Risk is especially high in young adults, individuals with immunosuppression, individuals with inflammatory bowel disease or diabetes, and those taking H-2 blockers or antacids. The primary source of infection is the consumption of fecally contaminated food or water ("Travelers' Diarrhea").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Of all the various strains of E. coli, O157:H7 has gained the widest attention in the US because of the much-publicized consequences from eating undercooked beef. Generally, the illness is mild and resolves in less than 10 days. But, mostly in children under 5 and the elderly, the disease may result in red blood cell destruction and kidney failure (hemolytic uremic syndrome, or HUS). This occurs in 2% to 7% of O157:H7 infections. In the US, HUS is the greatest cause of acute kidney failure in children, and most of these cases are caused by E. coli O157:H7. Beef is not the only source of this strain; it is also found in any foods contaminated with feces, such as lettuce, vegetables, unpasteurized milk and juice, and in contaminated swimming or drinking water. The bacteria also spread from infected persons when hand washing is not adequate.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with EHEC (STEC) typically have bloody diarrhea and abdominal cramps, pain or tenderness, but usually no fever. Sometimes an individual may report a mild fever. Symptoms begin 2 to 8 days after exposure to the bacteria and last 5 to 10 days.

Individuals with ETEC produce large quantities of watery diarrhea. Some individuals also report abdominal cramps, vomiting, and exhaustion. Symptoms begin 10 to 72 hours after exposure and last fewer than 5 days.

EIEC produces symptoms that include watery diarrhea, sometimes containing mucous, severe abdominal cramps, and fever. This diarrhea may become bloody.

Physical exam: The skin, mouth, and lips appear dry due to dehydration. Rapid breathing, drowsiness, or confusion may indicate acidosis, a condition in which the acid-base balance is disturbed due to prolonged diarrhea. Although the cause must be confirmed with testing, bloody or watery diarrhea alerts the physician to a diagnosis of diarrheal intestinal infection (gastroenteritis). Bloody diarrhea plus signs of kidney (renal) involvement may suggest EHEC (STEC).

Tests: EHEC (STEC) may be grown and identified from a stool specimen with a special E. coli O157:H7 culture (not a routine bacterial stool culture) and sensitivity testing. The organism may also be identified by a DNA probe test or by testing for the toxin it produces. Additional identifying information about the organism, such as might be needed when studying an outbreak, can be obtained from a serotyping test.

ETEC cannot be identified by a bacterial culture. It must be identified by a DNA probe test, a test for its toxin, or an immunoassay in which one of its proteins is detected.

EIEC also cannot be identified by bacterial culture. It is identified by a DNA probe test, an immunoassay in which one of its proteins is detected, or a bioassay in which its ability to invade tissue is detected. A clue to the presence of EIEC is the presence of white blood cells found during microscopic examination of a stool specimen.

Source: Medical Disability Advisor



Treatment

EHEC (STEC) is primarily treated with fluid and electrolyte replacement. Whether or not antibiotics should be used is still a matter of debate. There is evidence to suggest that some antibiotics may precipitate the development of complications (HUS). Antidiarrheal drugs should not be used.

ETEC is also primarily treated with fluid and electrolyte replacement. If the diarrhea is severe, antibiotics may be prescribed. Antidiarrheal drugs may help alleviate the symptoms but can keep the bacteria in the system longer.

EIEC is treated with antibiotics that may hasten the resolution of symptoms, especially in severe cases.

Complications require hospitalization, including intensive care treatment, renal dialysis, and blood transfusions.

Source: Medical Disability Advisor



Prognosis

Individuals with only the diarrheal phase of an E. coli intestinal infection usually have a complete recovery. ETEC and EIEC typically resolve without complications.

Most individuals with EHEC (STEC) who develop HUS (2% to 8% of cases) recover within a few weeks, but some have permanent damage or die ("E. coli").

Source: Medical Disability Advisor



Complications

Up to 8% of individuals with EHEC (STEC) develop the life-threatening condition called HUS in the second week following onset of diarrhea. In HUS, the absorbed bacterial toxin destroys red blood cells and causes renal failure. Some individuals with HUS need to have part of their bowel removed (bowel resection) due to hemorrhagic colitis. When absorbed into the bloodstream, E. coli toxins can also affect other organs such as the kidney. Prolonged or severe diarrhea can lead to severe dehydration and decreased blood pressure (hypovolemic shock).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who work with food or provide care to children or other individuals should be relieved of these duties until diarrhea has stopped and they have been cleared to return to work. Elimination of the diarrhea-producing E. coli is verified by two negative stool cultures collected at least 24 hours apart. If antibiotics were taken, the cultures should be collected at least 48 hours after the last dose of antibiotics.

Risk: Because individual-to-individual transmission of E-coli is a risk, work restrictions are necessary for infected individuals until stool samples are negative. Good personal hygiene including hand washing after toileting and before handling food is important both at work and home to prevent disease transmission.

Capacity: Capacity is influenced by the severity and frequency of the diarrhea.

Tolerance: Tolerance of symptoms varies according to the individual, although many individuals choose to work despite discomfort. Individuals concerned over frequent diarrhea may require ready access to bathroom facilities during recovery.

Accommodations: Employers willing to accommodate activities as needed can have employees return to work earlier.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

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 abdominal cramps, bloody or watery diarrhea, and/or fever?
  • When did the symptoms begin?
  • What did individual have to eat or drink 2 to 8 days prior to the diarrhea?
  • Has individual traveled to a developing country recently?
  • Was there evidence of dehydration or electrolyte imbalance in the physical exam?
  • Was diagnosis of E. coli infection confirmed with appropriate cultures (i.e., stool cultures)?
  • Was a DNA probe test, toxin test, or bioassay performed?
  • Was sensitivity testing done to identify appropriate antibiotic therapy?

Regarding treatment:

  • Have symptoms of dehydration or electrolyte imbalance been treated as needed with intravenous fluid replacement?
  • Has the appropriate antibiotic therapy been administered?
  • Have the fever and other symptoms resolved with the treatment? If not, were cultures repeated to rule out the possibility of antibiotic resistance or secondary infection?
  • Were appropriate changes or additions made to the current antibiotic treatment?

Regarding prognosis:

  • Did individual receive prompt and appropriate supportive care and antibiotic treatment?
  • Based on underlying cause, severity of symptoms and general health of individual, what was the expected outcome?
  • Did individual experience any associated complications (systemic infection, shock, HUS) that could affect recovery and prognosis?
  • Does the individual have any underlying conditions (e.g., chronic illness, immune suppression) that could affect ability to recover?

Source: Medical Disability Advisor



References

Cited

"Escherichia Coli (E. coli)." Centers for Disease Control and Prevention. 3 Aug. 2012. U.S. Department of Health and Human Services. 16 Aug. 2014 <http://www.cdc.gov/ecoli/general/index.html#how_common>.

"Travelers' Diarrhea." Centers for Disease Control and Prevention. 21 Nov. 2006. U.S. Department of Health and Human Services. 16 Aug. 2014 <http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm>.

Source: Medical Disability Advisor






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