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.

Salmonellosis


Related Terms

  • Nontyphoidal Enterocolitis
  • Nontyphoidal Salmonella Infection
  • Salmonella Gastroenteritis

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Compromised immune system
  • HIV/AIDS
  • Inflammatory bowel disease
  • Malnutrition
  • Sickle cell anemia

Factors Influencing Duration

Length of disability may be influenced by the severity of symptoms, response to treatment, or any underlying disease, including immunocompromised conditions such as AIDS, sickle cell anemia, or inflammatory bowel disease.

Medical Codes

ICD-9-CM:
003.0 - Salmonella Gastroenteritis, Salmonellosis

Overview

Salmonellosis is an infection caused by the bacteria Salmonella enterica. The genus Salmonella (which belongs to the family Enterobacteriaceae) has 3 species: S. enterica, S. bongori, and S. subterranean, which include more than 2,500 known serotypes, some of which have a name. The scientific name sometimes is shortened to include only the genus and serotype; for example, S. enterica, subspecies enterica, serotype enteritidis, is called S. enteritidis. The 3 main serovars of S. enterica are enteritidis, typhimurium, and typhi.

The genus Salmonella may also be divided into 3 groups based on the degree of adaptation of the organism to humans: (1) those with a broad host range, which includes more than 2,000 serotypes such as S. enteritidis and S. typhimurium that produce gastroenteritis and account for 85% of all Salmonella infections in the US; (2) those adapted to humans and having no nonhuman hosts (S. typhi and S. paratyphi types A, B [S. schottmülleri], and C [S. hirschfeldii]), which are pathogenic only in humans and commonly produce enteric (typhoid) fever; and, finally, (3) those adapted to nonhuman hosts or causing disease almost exclusively in animals (some strains, such as S. dublin [cattle], S. arizonae [reptiles], and S. choleraesuis [swine], also produce disease in humans).

The most common form of salmonellosis produces gastrointestinal upset or "food poisoning." The course of the disease depends on the subspecies of S. enterica ingested.

All types of salmonellosis can be transmitted when the individual eats contaminated foods, particularly meat, poultry, eggs, and raw milk. Infection can also occur if organisms in feces directly or indirectly contaminate food. This can happen if vegetable or fruit crops are sprayed with sewage, flies settle on feces and then on food, or food is handled by an individual who did not wash his or her hands. Contaminated food left out in warm conditions for any length of time can rapidly develop a large colony of bacteria without signs of food spoilage. Touching infected animals such as baby chicks, ducks, turtles, and pet reptiles can also transmit salmonellosis. It is rare for medical products derived from animals such as thyroid extracts, bile salts, or pancreatin to be contaminated with the bacteria.

Prevention of salmonellosis includes thorough cooking of all meats, poultry, and eggs. Milk, dairy products, and drinking water should also be protected from contamination. Countertops and utensils should be thoroughly cleaned, especially when used in the preparation of raw meat or poultry. Proper hand-washing should be done during food preparation, before eating, after using the restroom, and after touching animals, especially reptiles. Carriers (individuals who harbor the bacteria but have no noticeable symptoms) should not be permitted to work as food handlers. Appropriate food storage is also important.

Appropriate waste disposal is important even after an infection resolves because individuals continue to pass Salmonella bacteria in their stools for several weeks.

Incidence and Prevalence: Salmonellosis is almost certainly underreported, because the disease is usually self-limiting and has symptoms similar to many other illnesses. However, it is estimated that there are 40,000 reported cases in the US each year ("Salmonellosis") and over 1 million unreported cases. Worldwide salmonellosis is common, and its incidence seems to be increasing (Klochko). It is especially common in developing countries and in areas where natural disasters disrupt waste and water treatment.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals under age 5 and over age 60 are at higher risk for this disease and are likely to develop more severe cases if they are infected. There is some risk of transmission from an infected mother or family member to newborns and infants. Individuals with depressed immune systems, such as those with multiple sclerosis or HIV/AIDS, are at increased risk of contracting salmonellosis. Individuals in institutions (jails, nursing homes) are also at higher risk.

Source: Medical Disability Advisor



Diagnosis

History: When caused by Salmonella, symptoms of acute gastroenteritis usually occur 8 to 48 hours after eating contaminated foods or liquids (incubation period). Symptoms last 3 to 7 days and may include high fever, chills, headache, nausea, vomiting, painful abdominal cramps, and diarrhea. Rarely, the diarrhea may be bloody.

The infection may enter the bloodstream (Salmonella bacteremia), or can cause focal infections (with or without sustained bacteremia) with pain in the involved organ or referred pain. The individual may complain of aching in joints or bones.

Physical exam: Physical findings in acute gastroenteritis may include fever and abdominal tenderness and distention, but these may apply to any number of conditions (nonspecific). Signs of dehydration may include blood pressure that rises or falls when the individual changes position (orthostatic blood pressure), thirst, decreased urine output, dry mucous membranes, sunken eyes, decreased skin tension (turgor), headache, and dizziness or lightheadedness.

Tests: Stools are examined for the presence of white blood cells. If present, a stool culture is indicated to identify the organism. A complete blood count (CBC) or blood culture may also be done when infection is suspected of entering the bloodstream (Salmonella bacteremia).

Source: Medical Disability Advisor



Treatment

Salmonella gastroenteritis infections are usually time-limited. Treatment of uncomplicated cases is primarily supportive. Dehydration is avoided by replacing fluids and electrolytes. Severe cases may require hospitalization for administration of intravenous fluids.

Treatment with antibiotics is indicated for high-risk individuals who are malnourished, severely ill, or have sickle cell disease. Depending on the individual's condition, antibiotics can be given either orally or intravenously. Since relapse is common in HIV-infected individuals, lifelong suppressive therapy may be required.

Individuals with asymptomatic carrier state do not play a major role in outbreaks, and rarely require antibiotics.

Source: Medical Disability Advisor



Prognosis

Salmonella gastroenteritis is usually a self-limited disease, with most cases resolving symptoms of fever within 48 to 72 hours and symptoms of diarrhea within 3 to 7 days.

Source: Medical Disability Advisor



Complications

Complications of Salmonella gastroenteritis include severe dehydration, shock, collapse, bacteremia, and Reiter's syndrome (reactive arthritis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Due to initial fatigue, sedentary work responsibilities with frequent breaks may be required until strength and stamina return.

Risk: Risk is a consideration for individuals working in food service or other jobs that involve handling of food or beverages. Work restrictions may be necessary for infected individuals until stool samples are negative, and carriers of the bacteria may require job reassignment. Good personal hygiene, including washing one’s hands after using the toilet and before handling food, is important both at work and home to prevent disease transmission.

Capacity: Capacity is influenced by the severity of fever, vomiting, and diarrhea.

Tolerance: Tolerance of symptoms varies according to the individual, although many individuals choose to work despite discomfort. Individuals affected by 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. Individuals working in food and beverage service may require temporary reassignment.

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 the diagnosis of salmonellosis been confirmed? What type of infection occurred? Salmonella gastroenteritis, Salmonella bacteremia, or focal infection?
  • Could the symptoms be caused by an organism other than Salmonella?
  • Has the infection spread to other organs in the body?
  • Does individual have additional illnesses that are contributing to the disease, such as sickle cell disease, inflammatory bowel disease, malnourishment, or suppressed immune system?

Regarding treatment:

  • Has additional treatment been required, such as rehydration therapy? Antibiotics?
  • If current antibiotic therapy seems ineffective, would a change in antibiotics be warranted? Has a sensitivity test been done to rule out antibiotic-resistant strains of organisms?
  • Was there evidence of Salmonella bacteremia? If so, did individual receive appropriate supportive care (i.e., hospitalization, intravenous fluids, etc.) and antibiotics?

Regarding prognosis:

  • Based on the severity of symptoms and general health of individual, what was the expected outcome? Has adequate time elapsed for recovery?
  • Does individual have any underlying condition such as sickle cell disease, inflammatory bowel disease, implants and prosthetic devices, malnutrition, or a weakened immune system that may influence the severity of illness or individual's ability to recover? If so, is the underlying condition being addressed in the treatment plan?
  • Has individual experienced any relapse? Is lifelong prophylactic treatment warranted?
  • Has individual been evaluated to rule out the possibility of a carrier state? If so, what measures are being taken to prevent disease transmission?

Source: Medical Disability Advisor



References

Cited

"Salmonellosis." National Center for Emerging and Zoonotic Infectious Diseases. 16 Nov. 2009. Centers for Disease Control and Prevention. 9 Jun. 2015 <http://www.cdc.gov/nczved/divisions/dfbmd/diseases/salmonellosis/#how_common>.

Klotchko, Alena, and Mark R. Wallace. "Salmonellosis." eMedicine. 25 Sep. 2014. Medscape. 9 Jun. 2015 <http://emedicine.medscape.com/article/228174-overview#showall>.

Source: Medical Disability Advisor






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