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.

Rocky Mountain Spotted Fever


Related Terms

  • Rocky Mountain Fever
  • Spotted Fever
  • Tick Fever
  • Tick Typhus

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Dermatologist
  • Gastroenterologist
  • Hematologist
  • Infectious Disease Internist
  • Nephrologist
  • Neurologist
  • Ophthalmologist
  • Psychiatrist

Comorbid Conditions

  • Compromised immune system

Factors Influencing Duration

Length of disability may be influenced by the individual's age, delay in diagnosis or treatment, the presence of complications, and the severity of the disease.

Medical Codes

ICD-9-CM:
082.0 - Tick-borne Rickettsioses; Spotted Fevers, Rocky Mountain Spotted Fever, Sao Paulo Fever

Overview

Rocky Mountain spotted fever is an acute infectious disease caused by the bacterium Rickettsia rickettsii. It is transmitted by several different ixodid (hard) ticks, the most common known as the dog tick (Dermacentor variabilis) and the wood tick (Dermacentor andersoni). Ticks infected with Rickettsia rickettsii transmit the infection to humans, either through a direct bite or during removal of an infected tick from another person or animal. This infection is characterized by persistent fever (of about 102° F [38.9° C]), chills, severe headache, muscle aches, nausea and vomiting, fatigue, and lack of appetite (anorexia). Later a spotted (maculopapular) centripetal skin rash may also develop. Rocky Mountain spotted fever is a serious illness. It is theoretically completely curable if treated early and appropriately. However, early diagnosis is difficult because symptoms mimic those of many other bacterial and viral illnesses.

Incidence and Prevalence: About 1,800 to 2,000 new cases of Rocky Mountain spotted fever are reported each year in the US (CDC).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Despite its name, Rocky Mountain spotted fever occurs throughout most of the US, southern Canada, Mexico, Central America, and parts of South America. In the US, ticks infected with this bacterium are found in all states, except presumably in Alaska and Hawaii, where the disease in not notifiable. Most cases occur in the southeastern and south central states. Only a small percentage of individual ticks are infected, although dense clusters of infected ticks may exist in certain parks or neighborhoods. Peak incidence is from June to July, but infection can occur at any time the weather is warm and ticks are active.

Although the infection can occur in individuals of any age, the number of reported cases increases with increasing age, with the highest number among those 55–64 years old. Men, American Indians and people over 40 are most likely to be infected. Besides outdoor activity in warm months, contact with dogs and living near a wooded area with tall grass will increase one's risk of infection (CDC).

The highest mortality rates occur in young children, especially those aged 5-9, American Indians, immunosuppressed patients, and those who receive delayed diagnosis or treatment (CDC; Dahlgren).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report recent wilderness activities or travel to an endemic area. They may report a tick bite, but many do not. Symptoms appearing 2 to 14 days after infection include persistent high fever, chills, severe headache, muscle pain, and extreme exhaustion (prostration). In some cases nausea and vomiting, restlessness, insomnia, and irritability may be reported. Later and less frequently, abdominal pain, joint pain, cough, confusion, or stupor are reported.

Two to 6 days following the onset of symptoms, small pink spots may appear on the wrists and ankles. This non-tender and non-itchy rash then spreads to the palms of the hands and soles of the feet before spreading over the rest of the body (centripetal). As vessels bleed beneath the skin, the rash darkens and develops bruised-looking areas called petechiae. Additional symptoms that may be associated with Rocky Mountain spotted fever include excessive thirst, hallucinations (rare), diarrhea, loss of appetite, and abnormal sensitivity to light (photophobia).

Physical exam: Individuals may present with a fever that can be as high as 106° F (41.1° C), conjunctivitis, and the characteristic rash. Pressing with hands (palpation) on the abdomen may reveal tenderness and an enlarged spleen (splenomegaly), and occasionally an enlarged liver (hepatomegaly). In severe cases, the individual may look very ill. Drowsiness or sluggishness (lethargy), mental confusion and disorientation, stupor, seizures, and coma may be evident. It should be noted that many of these symptoms may be absent, and that about 10% of infected individuals never present with a rash (CDC). In other cases the rash is faint and/or localized, making diagnosis difficult. Diagnosis is almost always made on the basis of presenting symptoms rather than on the results of tests.

Tests: Before the rash appears, Rocky Mountain spotted fever resembles many other infections, making diagnosis very difficult. Blood tests reveal a low level of sodium (hyponatremia), a decreased platelet count (thrombocytopenia), and elevated serum creatinine (hypercreatininemia). Blood tests are not definitive, but may rule out other conditions such as thrombocytopenic purpura. Urine tests may detect the presence of blood (hematuria) or protein (proteinuria). During the acute phase of the illness, diagnosis can be made by isolating the causative bacterium through skin biopsies. By the second week, blood tests that confirm the diagnosis will reveal a rise in antibody titer that can be detected by immunofluorescent Antibody (IFA), specific complement fixation test, and microscopic latex agglutination tests. However, death may occur before a definitive test can be performed.

Source: Medical Disability Advisor



Treatment

Rocky Mountain spotted fever is treated with tetracycline antibiotics (doxycycline), either given orally or intravenously (IV), depending on the severity of symptoms. Not all tetracyclines are equally effective and are contraindicated in pregnant women. Individuals with mild disease may be treated on an outpatient basis, but must be vigilant in watching for the signs and symptoms of progression or complications. Moderately or severely ill individuals should be hospitalized and treated with IV antibiotic drug therapy. If the lungs become involved, oxygen therapy and/or assisted ventilation might be necessary. Packed red blood cells and/or platelet transfusions may also be necessary in cases in which anemia and/or severe bleeding develops.

Source: Medical Disability Advisor



Prognosis

With early treatment, the illness usually subsides after about 2 weeks and there is complete recovery, although fatigue may linger for an extended period. In severe or complicated cases, the recovery period will be longer and holds the possibility of neurological damage. Death occurs in approximately less than 1% of individuals who receive treatment (Dahlgren). A higher probability of death is associated with older (70 and older) and younger (5-9 years) persons, American Indians, and those who live in the western U.S. Those who were hospitalized late in the course of the illness (6 days after onset) were more than 27 times as likely to die as those who received treatment but were not hospitalized. Hospitalized survivors were admitted earlier (3 days after onset) (Dahlgren). Early, accurate diagnosis and treatment are key to preventing complications and facilitating complete and rapid recovery.

Source: Medical Disability Advisor



Complications

Complications may include encephalopathy; pneumonia; heart, lung or kidney failure; hemorrhage; inflammation of the heart (myocarditis); pulmonary edema; tissue death (gangrene); vascular damage to brain, lungs, or heart; and swelling or inflammation of the optic nerve (papilledema) where it enters the eyeball.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Extended sick leave may be required. Specific work restrictions or accommodations depend on the individual's job requirements. Strenuous activity may need to be modified until physical stamina returns.

Risk: Occupations requiring exposure to tick-infested areas may present an increased risk of recurrence or infection. At-risk workers should wear long sleeves and pants and apply tick repellant.

Capacity: Capacity is not affected in most cases, but if an individual progresses to late disease, then there may be more significant limits due to impacts on various organs or joints. The capacity would then be assessed based on the affected body part.

Tolerance: Fatigue may persist for 2 months after a cure. Providing frequent work breaks and modifying schedule and duties would be helpful in these cases.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 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:

  • Did individual present with history of tick bite?
  • Has the diagnosis of Rocky Mountain spotted fever been confirmed?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was antibiotic therapy started promptly?
  • Has individual been compliant with the treatment regimen?
  • If not, what can be done to increase compliance?
  • During treatment, has individual experienced any complications such as inadequate blood circulation or fluid accumulation in the lungs or brain?
  • Have complications responded to treatment?

Regarding prognosis:

  • Has illness extended beyond 2 weeks?
  • Do symptoms persist despite treatment?
  • Did individual complete entire course of drug therapy?
  • Did individual follow physician's instructions regarding bed rest and/or restricted activity?
  • Would individual benefit from evaluation by an infectious disease specialist?
  • If case was severe or complicated, did neurological damage occur?
  • Would individual benefit from involvement in a rehabilitation program?
  • Does individual have any underlying conditions that may affect recovery?
  • Has individual experienced any complications related to the infection?

Source: Medical Disability Advisor



References

Cited

"Rocky Mountain Spotted Fever: Statistics and Epidemiology." CDC. 5 Sep. 2013. Centers for Disease Control and Prevention. 4 Nov. 2014 <http://www.cdc.gov/rmsf/stats/>.

Cunha, Burke A. "Rocky Mountain Spotted Fever." eMedicine. Eds. Michael Stuart Bronze, et al. 31 Jan. 2013. Medscape. 4 Nov. 2014 <http://emedicine.medscape.com/article/228042-overview>.

Dahlgren, F. S., et al. "Fatal Rocky Mountain Spotted Fever in the United States, 1999-2007." American Journal of Tropical Medicine and Hygiene 86 (2012): 713-719.

Source: Medical Disability Advisor






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