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.

Shigellosis


Related Terms

  • Bacillary Dysentery

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Immune system disorders
  • Malnutrition

Factors Influencing Duration

Length of disability may be influenced by the severity of symptoms, failure or delay in treatment, response to treatment, the presence of complications, and the presence of any disease or condition that reduces the effectiveness of the immune system, such as HIV/AIDS, multiple sclerosis, diabetes mellitus, chemotherapy, or treatment with immunosuppressant drugs.

Medical Codes

ICD-9-CM:
004.0 - Shigella Dysenteriae, Infection by Group A Shigella (Schmitz) (Shiga)
004.1 - Shigella Flexneri, Infection by Group B Shigella
004.3 - Shigella Sonnei, Infection by Group D Shigella
004.8 - Shigella Infections, Other Specified
004.9 - Shigellosis, Unspecified

Overview

Shigellosis is an acute infectious disease caused by several different species of Shigella bacteria. The bacteria cause diarrhea, fever and stomach cramping in the infected individual. There are 4 major subgroups of Shigella: A (S. dysenteriae), B (S. flexneri), C (S. boydii), and D (S. sonnei). The two most common types of Shigella bacteria are S. sonnei (over 66% of cases) and S. flexneri (about 33% of cases). S. dysenteriae is rare in the US. It is isolated mainly from imported cases and may cause severe disease and complications.

Many cases of shigellosis are linked to unsanitary habits such as failure to wash hands after toilet use. The infection primarily associated with the S. sonnei form of the bacteria is spread person-to-person or through contamination of food or drinking water. As a result, shigellosis is associated with outbreaks in day care centers, nursing homes, and institutionalized populations. Outbreaks often occur in the general population when sanitation is inadequate as after floods, earthquakes, or in war zones. Infections may also spread indirectly in areas of inadequate waste disposal, where flies settle on feces and then on food.

Incidence and Prevalence: Shigellosis is almost certainly underreported because the disease is usually self-limiting and has symptoms similar to many other illnesses. About 14,000 reported cases in the US each year; however, the actual number of infections may be about 280,000 (CDC). Shigellosis is most common in children aged 6 months to 5 years. Adults tend to have milder symptoms than children. Shigellosis is found worldwide, but is more common in developing countries and where war and natural disaster disrupt water and sewage treatment and force people into confined living situations.

Source: Medical Disability Advisor



Causation and Known Risk Factors

In developed countries, Shigellosis is most likely to occur in institutions such as jails, nursing homes, hospitals, and day care centers. It also occurs more frequently in areas where people live in crowded, unsanitary conditions such as refugee camps.

Dramatically elevated rates of shigellosis in HIV-infected persons point to HIV infection as an important risk factor for shigellosis.

Travelers to Southeast Asia are more likely to contract antibiotic-resistant Shigella.

Source: Medical Disability Advisor



Diagnosis

History: The incubation period is 1 or 2 days. The illness usually has a sudden onset of symptoms, including painful abdominal cramps with frequent, urgent episodes of watery diarrhea. Other symptoms may include fever, chills, headache, muscle aches, loss of appetite (anorexia), the feeling of constantly needing to pass stool (tenesmus), nausea, and vomiting. Within days, diarrhea may become mixed with blood, pus, and mucus. The individual becomes progressively weaker. Persistent diarrhea may cause dehydration and weight loss. The illness occasionally begins with bloody stools.

Physical exam: The physical exam is nonspecific. There may be evidence of fever, lower abdominal tenderness, or hyperactive bowel sounds. The individual may have signs of dehydration, including blood pressure that varies with body position (orthostatic hypotension), dry mucous membranes, sunken eyes, and decreased skin tension (turgor). Rectal exam may be painful due to inflammation caused by constant diarrhea.

Tests: Direct microscopic examination of stained smears may reveal many leukocytes and red cells in the stool. Diagnosis is confirmed by identifying the infectious organisms in a stool culture.

If toxins are suspected in the blood (sepsis or septicemia), a complete blood count (CBC) may be done to detect an elevation of the white blood cell count.

An examination of the inside of the colon through use of a lighted magnification instrument (colonoscopy) may reveal areas of congested rectal mucosa, small flat irregular blue or purple spots (ecchymoses), and sometimes large areas of ulceration.

Source: Medical Disability Advisor



Treatment

Shigellosis is a self-limited disease. The illness usually subsides after a week or so, but severe cases may last several weeks. Dehydration is treated by replacing fluids and electrolytes with oral rehydration fluids. Antibiotic therapy may be prescribed in severe cases, although some forms of the bacteria are resistant to antibiotics, thus antibiotic susceptibility testing should be done. Antimotility agents should not be used. Antispasmodic drugs are helpful when cramps are severe. Nonsteroidal anti-inflammatory medications (NSAIDs), pain relievers (analgesics), or corticosteroids may be prescribed for individuals who develop a pain from reactive arthritis.

Source: Medical Disability Advisor



Prognosis

Most individuals recover completely without any lasting effects. Death, in a few rare cases, is usually the result of unusual strains of the bacteria. Infection with certain strains of S. flexneri bacteria, may lead to reactive arthritis (particularly in individuals with the HLA-B27 genotype).

Source: Medical Disability Advisor



Complications

Complications include renal failure, severe dehydration, or shock. Septicemia, a life-threatening illness, can occur when bacteria multiply rapidly in the bloodstream, invading other body organs. In the chronic form of the disease, caused by the S. flexneri bacteria, individuals are at risk for developing a type of chronic reactive arthritis (Reiter's syndrome).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Extended leave of absence may be required for recuperation. If chronic complications develop, individual may be unable to perform strenuous tasks.

Risk: Because risk is a consideration for individuals working in food and beverage services and for those working with institutionalized populations, temporary work restrictions may be necessary for infected individuals until symptoms abate. 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 of symptoms (e.g., urgent diarrhea, abdominal pain, nausea, vomiting, fever). Apart from food and beverage handlers, most individuals are able to perform work duties during recovery.

Tolerance: Tolerance of symptoms varies according to the individual, although many individuals choose to work despite discomfort and inconvenience. Individuals concerned over frequent, urgent diarrhea may require ready access to bathroom facilities to remain productive upon their initial return to work.

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:

Regarding treatment:

  • Have the appropriate antimicrobial agents been prescribed? Were associated symptoms treated appropriately with antispasmodic medications or analgesics?
  • Was antibiotic susceptibility testing done?
  • Have symptoms persisted despite treatment? If so, was individual re-evaluated to rule out secondary infection Were appropriate adjustments made in antimicrobial therapy?

Regarding prognosis:

  • Has adequate time elapsed for recovery (up to several weeks)?
  • Have symptoms resolved, persisted, or changed despite treatment? Does diagnosis need to be revisited?
  • Has the possibility of chronic Shigella been considered? If so, does individual have symptoms that may suggest the associated condition or reactive arthritis? Are these symptoms being addressed in the treatment plan?
  • Has individual experienced complications such as dehydration, shock, or septicemia that may affect recovery?
  • Does individual have any underlying conditions such as HIV, diabetes mellitus, or malnutrition that could affect recovery and prognosis? If so, are these underlying conditions being addressed in the treatment plan?

Source: Medical Disability Advisor



References

Cited

"Shigella – Shigellosis." National Center for Emerging and Zoonotic Infectious Diseases. 5 Jun. 2015. Centers for Disease Control and Prevention. 24 Jun. 2015 <http://www.cdc.gov/shigella/index.html>.

Source: Medical Disability Advisor






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