Sign-in
(your email):
(case sensitive):



 
 

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.

Botulism


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
005.1 - Botulism; Botulism NOS; Food Poisoning Due to Clostridium Botulinum

Related Terms

  • Food Poisoning

Overview

Botulism is a serious but rare type of food poisoning caused by the toxin of the bacterium Clostridium botulinum. The toxin affects the transmission of nerve impulses and cause symmetric cranial nerve palsies followed by symmetric descending weakness and flaccid paralysis of both voluntary and involuntary muscles such as those in the throat and those that control breathing (muscles of respiration) with possible progression to respiratory failure and death.

Of the seven types of botulinum toxin (A-G), only types A, B, E, and rarely F, cause disease in humans; type A toxin causes the most severe syndrome.

The most common form of human botulism throughout the world is foodborne botulism caused by eating contaminated food. Even minute amounts of bacteria can lead to severe poisoning. Because the bacterium, which can survive under adverse conditions, can only multiply in the absence of air (anaerobic), it thrives in improperly preserved or canned food that has been contaminated during preparation.

One sign of contaminated food is a can with a bulging lid or sides; contaminated foods may look and taste normal. Boiling food for at least 30 minutes at 250° F (121° C) can destroy the toxin.

Botulism bacteria are also found in the soil. Wound botulism can occur if these bacteria enter skin broken during an injury and if the bacteria then produce toxin.

Incidence and Prevalence: An average of 154 new cases of botulism are reported in the US each year. Of these, an estimated 24 cases are from food and about 3 are wound botulism. Infant botulism accounts for the remainder (Chan-Tack) Almost all wound botulism cases are associated with illegal drugs injection ("Botulism"). Botulism is widespread. In the US, the geographic distribution of cases by toxin type parallels the distribution of organism types found in the environment. Toxin A predominates in the west of the Mississippi River; toxin B, although widely distributed, is more common in the eastern United States; and toxin E predominates in northern latitudes (Pacific Northwest, Alaska, and the Great Lakes area), often associated with fish products. Alaska Natives have one of the highest rates of botulism in the world (Chan-Tack). Food botulism affects men and women equally; men have higher rates of wound botulism than females (Chan-Tack).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Foods most commonly infected with the toxin are spiced, smoked, vacuum-packed, or home-canned foods that are eaten without cooking. In the US, foodborne botulism has been associated primarily with improperly home-canned food, particularly vegetables, fruit, and condiments, and less commonly with meat and fish.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms usually appear between 12 and 36 hours after eating contaminated food but can appear as early as 6 hours or as late as 10 days. They may include difficulty swallowing or speaking, dry mouth, nausea, vomiting, abdominal cramps, diarrhea, slurred speech, blurred vision, double vision (diplopia), and marked fatigue. As paralysis progresses, symptoms include weakness of upper and lower extremities, dizziness, difficulty walking, and difficulty breathing (dyspnea).

Physical exam: The exam may reveal dilated, fixed pupils, drooping eyelids (ptosis), decreased gag reflex or tongue weakness, partial paralysis of face, weakness of upper and lower extremities, poor muscular coordination (ataxia), and decreased, absent, or increased deep tendon reflexes. Pulse is rapid and weak.

Tests: Bacterial culture or toxin analysis (assays) may be done on samples of blood (serum), stool, wound, or remnants of suspected food. Tests to exclude other conditions may include a brain scan, spinal fluid examination (lumbar puncture [LP]), and a test for myasthenia gravis. Nerve studies may be done by recording the electrical activity in the muscles through electromyography (EMG) or by skin testing.

Source: Medical Disability Advisor



Treatment

Maintenance of airway and breathing is crucial. Respiratory paralysis may lead to death unless mechanical assistance (respirator) is provided. In March 2013, the Food and Drug Administration approved the first antitoxin that neutralizes all toxins A-G. It is only given to adults. Although the antitoxin cannot undo the damage, it may slow or stop further damage, allowing the body to heal itself over the next few months. Antitoxin is most effective if given within 72 hours of symptom onset. Purgative drugs (cathartics) and enemas, and wound débridement, may be used to remove any unabsorbed toxin. Intravenous fluids may be given to prevent dehydration.

Wounds may require surgical treatment to remove the toxin-producing bacteria.

Source: Medical Disability Advisor



Prognosis

Botulism is a life-threatening condition. Suffocation due to paralysis of the respiratory muscles results in death in about 70% of untreated cases. Prompt treatment with antitoxin reduces the risk of death to 10-15% in foodborne botulism and 15-17% of wound botulism. Mortality from treated infant botulism is less than 1% (Chan-Tack).

Source: Medical Disability Advisor



Differential Diagnosis

  • Acute inflammatory polyneuropathy
  • Guillain-Barré syndrome
  • Lambert-Eaton syndrome
  • Magnesium toxicity
  • Myasthenia gravis
  • Tick paralysis

Source: Medical Disability Advisor



Specialists

  • General Surgeon
  • Infectious Disease Internist
  • Neurologist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation therapy may include exercises to improve muscle strength (including respiratory muscles), speech and swallowing therapy, and measures to improve other functions affected by the disease.

Source: Medical Disability Advisor



Comorbid Conditions

  • Anorexia nervosa
  • Immune system disorders

Source: Medical Disability Advisor



Complications

Complications include respiratory failure, aspiration pneumonia, abscess formation, neurological impairment, and persistent psychological problems. Up to 20% of individuals receiving antitoxin show adverse reactions, which can be life-threatening (Chan-Tack).

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability may be influenced by the severity of symptoms, the need for ventilatory support, the extent of residual impairment, or the presence of complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work accommodations may include a temporary transfer to sedentary duties and elimination of duties that require heavy lifting. The individual's work area may need to be relocated nearer to the entrance/exit in order to decrease the amount of walking required, or the employer may need to support a worker's ability to move from the parking lot to the work area (e.g., avoid stairs).

Risk: Botulism is not spread by person-to-person contact; therefore, there is no risk to coworkers of contracting the disease from an infected individual. Individuals that contracted botulism through a wound infection by working in the soil with a hand abrasion or cut may need to use protective gloves to prevent recurrence.

Capacity: Capacity is dependent on the speed of treatment with antitoxin therapy to slow paralysis and whether surgical wound débridement was necessary. Residual muscle weakness and dyspnea may affect the individual's ability to perform moderate to heavy work during recovery.

Tolerance: Dyspnea concerns are best addressed through metabolic stress testing or pulmonary function testing. Physical therapy for muscle strengthening may be of assistance.

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:

  • Has individual eaten any potentially contaminated food?
  • Does individual have a cut that was exposed to soil?
  • How long after exposure did the symptoms appear?
  • Does individual have difficulty swallowing or speaking? Dry mouth? Does individual have symptoms of nausea, vomiting, diarrhea, or abdominal cramps? Is vision blurred or double? Does individual have dilated fixed pupils? Ptosis? Is individual having trouble walking? Breathing?
  • Is there a decreased gag reflex, tongue weakness, or partial paralysis of face? Does individual have weakness of the extremities and ataxia? Were deep tendon reflexes decreased, absent, or increased?
  • Is the pulse rapid and weak?
  • Were blood, stool, and wound tests performed? Was the suspected food tested? Were nerve conduction studies done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was the individual given botulinum antitoxin? How soon after symptoms appeared?
  • Were purgative drugs (cathartics) and enemas used?
  • Was the wound debrided?
  • Were IV fluids needed?
  • Was a respirator necessary?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Did complications arise such as aspiration pneumonia or abscess?
  • Does individual have neurological impairment or persistent psychological problems?

Source: Medical Disability Advisor



References

Cited

"Botulism." Centers for Disease Control and Prevention. 25 Apr. 2014. U.S. Department of Health and Human Services. 13 Aug. 2014 <http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/>.

Chan-Tack, Kirk M. "Botulism." eMedicine. Eds. Burke A. Cunha, et al. 28 May. 2013. Medscape. 13 Aug. 2014 <http://emedicine.medscape.com/article/213311-overview>.

Source: Medical Disability Advisor