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.

Mononucleosis

mononucleosis in русский (Россия)

Related Terms

  • Glandular Fever
  • Infectious Mononucleosis
  • Kissing Disease
  • Mono

Differential Diagnosis

Specialists

  • Family Physician
  • Infectious Disease Internist

Comorbid Conditions

Factors Influencing Duration

The infection's severity and possible complications will influence the length of disability. Individuals with pre-existing immune disorders likely will need longer recovery time.

Medical Codes

ICD-9-CM:
075 - Infectious Mononucleosis; Glandular Fever, Monocytic Angina, Pfeiffers Disease

Overview

Mononucleosis is a contagious disease that is classically caused by the Epstein-Barr virus (EBV) (about 90% of cases); cytomegalovirus may cause a mononucleosis syndrome similar to that observed with EBV (5% to 10% of cases). The vast majority of adult Americans have been exposed to EBV and have built up antibodies that last for a lifetime, so mononucleosis is considered contagious primarily among adolescents and young adults.

The disease usually develops several weeks to 2 months after exposure to the virus, which spreads primarily through exchanges of saliva. Many individuals are unaware of the infection because symptoms often are nonexistent to very mild. Frequent shedding of the virus in oral secretions by asymptomatic individuals and the long incubation period often obscures the source of infection.

The incubation period of EBV is 2 to 8 weeks, followed by an acute phase of 2 to 8 weeks. During this time, the virus can shed intermittently.

Although immunity usually results after infection, in rare cases the disease may recur periodically.

Incidence and Prevalence: An estimated 95% of adults between the ages of 35 and 40 have been infected with EBV. If adolescents or young adults become infected with EBV, the virus usually causes infectious mononucleosis about 25% of the time ("Epstein-Barr Virus"). In less developed countries, mononucleosis is often seen in younger children.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Kissing, coughing, and sneezing are common ways of spreading infectious mononucleosis. Sharing contaminated eating utensils is also a common way of transmitting the disease, which is widespread at college campuses, public schools, and military bases.

Source: Medical Disability Advisor



Diagnosis

History: The individual typically reports a general feeling of illness (malaise) or fatigue at onset. Symptoms slowly become more specific and may develop into the triad of persistent sore throat (pharyngitis), fever with chills, and swollen lymph nodes (lymphadenopathy) in the neck and armpits; rash, headache, and loss of appetite may also be present. White patches may develop at the back of the throat. Less common symptoms include persistent muscle aches (myalgia), and nausea. The individual may also report exposure to a person infected with the disease. Most symptoms usually last from 2 to 8 weeks, but fatigue and malaise can linger for months. An individual with an extreme or advanced case of mononucleosis may also complain of pain in the left upper part of the abdomen, faintness, difficulty breathing (dyspnea), a rapid heart rate (tachycardia), low blood pressure (hypotension), and hemodynamic compromise indicating that the spleen has ruptured (less than 0.5% of cases).

Physical exam: The exam may show enlarged tonsils and lymphadenopathy. An enlarged spleen (splenomegaly) (about 50% of cases) or liver (hepatomegaly) may also be detected, and the individual may complain of tenderness when pressure is applied over the spleen or liver. Jaundice or a macular or papular rash is occasionally seen. Fever may be as high as 102° F (38.9° C). Patches of broken capillaries may be noted on the roof of the mouth (palatal petechiae) and swollen eyes (periorbital edema) may also be detected.

Tests: A complete blood count (CBC) may be performed. A white blood cell (WBC) count may show elevated WBC levels (leukocytosis) peaking between 10,000 and 20,000 during the second or third week after infection. A high lymphocyte (a type of white blood cell) count (lymphocytosis) with a high percentage of abnormal lymphocytes (more than 10%) also indicates the presence of the disease. Liver function tests (LFTs) may show abnormal function through increased bile pigment (serum bilirubin) and somewhat elevated levels of certain enzymes (serum transaminases [aspartate aminotransferase and alanine aminotransferase] and alkaline phosphatase). A positive Monospot blood test indicating the presence of antibodies to EBV is usually the best way of detecting short-term (acute) infectious mononucleosis. The best indicator of mononucleosis is the presence of IgM antibody to EBV viral capsid antigen, usually apparent when the infection is most active. In ongoing (chronic) or recurring cases of mononucleosis, antibodies needed to confirm the diagnosis may be absent.

Source: Medical Disability Advisor



Treatment

Since no specific treatment exists for mononucleosis, options for medical intervention are usually limited. Individuals may be advised to rest (although there is no evidence that extended rest shortens the duration of mononucleosis), and drink plenty of fluids. Paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce fever. Aspirin should be avoided in young children because of its association with Reye's syndrome. If an enlarged spleen is suspected, contact sports and strenuous activities may be curtailed because of the possibility of rupture. Other activities are reduced in accordance with the symptoms. Good hygiene also is recommended.

Drugs that suppress immune responses (corticosteroids such as prednisone) are sometimes used for treating complications such as preventing the throat from swelling and blocking the airway. However, some experts advise against use of steroids because of potential side effects such as an association with development of encephalitis or myocarditis. Other researchers recommend use of steroids for severe central nervous system involvement (e.g., Guillain-Barré syndrome), serious anemia, or low blood platelets (thrombocytopenia) (see Complications). Antiviral agents may inhibit replication of EBV but have not been shown to directly affect duration of the disease. Antibiotics may be used to treat a secondary bacterial infection such as tonsillitis or streptococcal infection. Although no specific treatment may be indicated for liver inflammation, the individual should be advised to avoid alcohol to prevent a worsening of symptoms.

Source: Medical Disability Advisor



Prognosis

The prognosis for uncomplicated mononucleosis is very good. Symptoms usually last no longer than a month, and most individuals will recover completely within 6 months. The incidence and duration of complications depend upon the severity of the initial EBV infection and how quickly it is diagnosed. Individuals with immune disorders may have greater difficulty recovering from the disease and any accompanying complications. Chronic or recurrent mononucleosis is rare. In other rare cases, fatalities occur when the spleen ruptures or liver failure is involved. Death is very rare.

Source: Medical Disability Advisor



Complications

Spleen enlargement and rupture is the most serious complication, occurring in approximately 0.5% of individuals, 90% of whom are men; autoimmune hemolytic anemia affects an estimated 1% to 3% of individuals, and a thrombocytopenia may occur in up to 50% of cases (Doerr). Neurological disorders may manifest as seizures, psychosis, cranial nerve palsies, encephalitis, Guillain-Barré syndrome, and central nervous system inflammation. Spatial distortion (metamorphopsia) may also occur. Airway obstruction occurs in an estimated 1 out of every 100 to 1,000 cases. Interstitial pneumonia may develop. When the virus invades the blood, inflammation may occur in other organs such as the heart, spleen, liver, parotid glands, kidneys, and pancreas.

In rare instances, mononucleosis can recur in an individual. Usually, the latent virus is reactivated when the body's immunity is suppressed. This can occur as a result of other infectious illnesses, steroid therapy, leukemia, radiation therapy, or generalized malignancy. In rare cases, symptoms may continue beyond 6 months, leading to a condition called chronic mononucleosis. Other serious complications related by complex mechanisms to EBV include nasopharyngeal carcinoma and Burkitt's lymphoma. Individuals with AIDS may develop tongue lesions (oral hairy leukoplakia) associated with EBV. In rare cases, a ruptured spleen may develop and become fatal. Another rare but sometimes fatal consequence of mononucleosis is liver disease and failure (fulminant hepatitis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Depending on the severity of symptoms, work activities may need to be curtailed or restricted until the individual, who usually suffers from fatigue, has completely recovered. If the liver, spleen, or kidneys are involved, care should be exercised in lifting heavy objects or bending to grasp and carry objects. Strenuous activity such as contact sports should be strictly avoided because of the possibility of rupturing the spleen. Most individuals can resume normal activities within 3 to 4 weeks.

Risk: Although more than 90% of adults have been infected by EBV and produce antibodies, EBV can be transmitted to others for several weeks or months during the infection and afterwards (perhaps up to a year and a half); hence, individuals must implement hygienic measures when sneezing or coughing and refrain from sharing personal items or food that may be contaminated with saliva, and from having close contact with coworkers. In an immunocompromised individual, working with heavy public contact, indigent or incarcerated populations, or in health care settings may place the individual at increased risk of further or recurrent infection. An individual with symptom onset within the last 24 to 48 hours is in a more infectious state and should avoid working in settings with immunocompromised individuals. Some risk can be mitigated by frequent hand washing, gloves, or masks.

Capacity: Capacity depends on the severity of symptoms and whether the liver, spleen, or kidneys are involved. Individuals performing heavy or very heavy work may require temporary job reassignment to less strenuous tasks until splenomegaly has resolved. There is no long term impact on capacity.

Tolerance: Tolerance factors include presence of fever, fatigue, malaise, nausea, and myalgia. Individuals are advised to rest, drink fluids, and reduce physical exertion until active infection has resolved.

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

Source: Medical Disability Advisor



Maximum Medical Improvement

90 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 had exposure to someone with mononucleosis?
  • Did individual report malaise?
  • Did individual develop fever, pharyngitis, and loss of appetite?
  • Were the lymph nodes swollen in the neck and under the armpits?
  • Does individual complain of left-sided abdominal pain? Faintness?
  • Did individual develop dyspnea? Tachycardia? Hypotension? Hemodynamic compromise?
  • On physical exam, were the tonsils enlarged? Was lymphadenopathy present? Palatal petechiae? Periorbital edema?
  • Were splenomegaly or hepatomegaly detected? Was spleen or liver tender to palpation?
  • Was jaundice or a rash seen?
  • Has individual had a CBC and LFTs? Monospot test?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was individual advised to rest?
  • Were acetaminophen or NSAIDs used to reduce fever?
  • Were corticosteroids used to treat complications?
  • Were antiviral agents used?
  • Were there any secondary bacterial infections? Were they treated with antibiotics?
  • Was individual advised to avoid alcohol?
  • Did partial or total splenectomy become necessary?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Is individual also following these restrictions at home and play?
  • Does individual have any conditions that may affect the ability to recover?
  • Has individual had recurrent mononucleosis?
  • Has individual had complications such as nasopharyngeal carcinoma? Burkitt's lymphoma? Fulminant hepatitis? Ruptured spleen?

Source: Medical Disability Advisor



References

Cited

"Epstein-Barr Virus and Infectious Mononucleosis ." Centers for Disease Control and Prevention. 7 Jan. 2014. U.S. Department of Health and Human Services. 16 Oct. 2014 <http://www.cdc.gov/epstein-barr/index.html>.

Doerr, Steven. "Mononucleosis." eMedicine Health. Ed. Scott H. Plantz. 6 Jun. 2014. WebMD, LLC. 20 Oct. 2014 <http://www.emedicinehealth.com/articles/16277-7.asp>.

Source: Medical Disability Advisor






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