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.

Strep Throat


Related Terms

  • Streptococcal Pharyngitis
  • Streptococcal Sore Throat
  • Streptococcal Throat Infection

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician
  • Family Physician
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Nephrologist
  • Otolaryngologist

Comorbid Conditions

Factors Influencing Duration

The length of disability is determined by the severity of disease at the time of treatment, the severity of symptoms, the type of treatment, the individual's response to treatment, and any complications. Older individuals and those with weakened immune systems may develop more severe infections.

Medical Codes

ICD-9-CM:
034.0 - Streptococcal Sore Throat; Septic Angina, Sore Throat; Streptococcal Angina, Laryngitis, Pharyngitis, Tonsillitis

Overview

Strep throat is a contagious bacterial infection that is caused by a group A streptococcal bacterium called Streptococcus pyogenes. The bacterium is highly contagious, and is spread through the air by sneezing or coughing or by physical contact; it also can be transmitted by food and water (Brusch). The incubation period is 24 to 72 hours (Choby).

In the vast majority of cases, strep throat is a short-lived, uncomplicated infection that is easily treated with antibiotics. Untreated strep throat, however, can lead to complications, including damage to the heart valves (rheumatic fever) or the tissue lining the inside of the heart (endocarditis) and kidney damage (glomerulonephritis). Very rarely death can occur due to failure of these organs. Some strains of streptococci produce a toxin that causes a red rash known as scarlet fever.

Incidence and Prevalence: Several million cases of strep throat are diagnosed each year. Strep throat accounts for up to 10% of all sore throat (pharyngitis) in adults, and 15% to 30% of cases in children (Halsey).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Strep throat infections spread easily in schools, military barracks, and other areas where individuals are in close, continued contact. In temperate climates, cases tend to peak in late winter or early spring (Choby, Khan). Individuals with compromised immune systems are not only at a higher risk for strep throat, but they also tend to experience more severe symptoms. Fatigue, smoking, and excessive alcohol consumption reduce immunity and increase an individual's risk of contracting this illness. Children aged 5 to 15 are more likely to contract the infection than younger children or adults (Halsey). Both sexes and all races are equally affected (Halsey).

Source: Medical Disability Advisor



Diagnosis

History: Individuals usually complain of the sudden development of sore throat with pain on swallowing. Other symptoms may include headache, loss of appetite, fatigue, chills, and/or hoarseness. Occasionally, nausea, vomiting, or abdominal pain also may occur. Upon questioning, the individual may reveal contact with another infected individual.

Symptoms of complicated strep disease may include persistent pharyngitis, joint pain, skin rash, abdominal pain, and occasionally involuntary movements. Individuals may report the sudden appearance of blood in the urine that indicates kidney involvement. There also may be swelling around the ankles or eyes and shortness of breath or fatigue.

Physical exam: Most individuals with strep throat experience fever (over 100.4° F [38° C]) and a painful sore throat (Brusch, Choby). The throat is beefy red upon examination, and the tonsils are enlarged. White spots on the throat (collections of pus) may also be present. Lymph nodes in the neck may be tender and enlarged.

Advanced streptococcal infection can also involve the joints, causing acute arthritis that may result in multiple painful, swollen joints (polyarthritis). A red, raised rash may appear on the skin for short periods of time. If the infection has affected the heart valves, a heart murmur may be detected. Elevated blood pressure or swelling (edema) may indicate kidney involvement.

Tests: Strep throat typically is diagnosed by swabbing the back of the throat (pharynx) and tonsils, and then culturing the collected bacteria on a special culture medium called blood agar for 24 to 48 hours. A rapid antigen detection test (RADT) can be done immediately in the doctor's office and has 90% to 99% sensitivity for the bacterium (Choby). Negative results may be retested using the standard blood agar culture. Newer enzyme-linked immunosorbent assays, optical immunoassay detection of cell wall carbohydrates, and tests for nucleic acid identification can provide results within a few hours but are more expensive and not as widely available (Choby). In systemic infection, bacteria may be isolated from blood, or the infection may be diagnosed indirectly by the presence of streptococcus-specific antibodies in serum. When glomerulonephritis is suspected, a urinalysis will show protein or blood in the urine, and bacteria may be cultured from either the blood or urine.

Source: Medical Disability Advisor



Treatment

The majority of cases of strep throat will spontaneously resolve within 4 days without treatment (Halsey). Despite this, it is important to treat strep throat with antibiotics to reduce the risk of complications and to prevent its spread (Brusch, Halsey). The type of antibiotic chosen varies, depending on the individual, but penicillin drugs usually are the first choice in nonallergic individuals. Other useful antibiotics include erythromycin, azithromycin, and clarithromycin; oral cephalosporins may also be used (Khan).

Most antibiotics given to treat strep throat are taken for 10 days. Although some research suggests that in children, antibiotics given for a shorter duration (2 to 6 days) may be comparably effective (Altamimi), these findings must be interpreted with caution. In moderate to severe infections, a single dose of a long acting antibiotic may be injected intramuscularly (Brusch). Individuals are considered to no longer be contagious 24 hours after starting antibiotic treatment. Individuals who do not feel better after 2 to 3 days should return to the doctor, because failure to improve suggests an antibiotic-resistant strain of streptococcus.

Nonprescription medications may be used for relief of pain (analgesics) and to reduce fever (antipyretics). Swallowing warm liquids may help with sore throat pain relief.

If systemic disease develops, individuals must take antibiotics to treat residual strep throat infection. Anti-inflammatory drugs help to control joint pain and swelling. For more serious inflammation, corticosteroid drugs may be needed. If rheumatic fever develops, hospitalization and further antibiotic therapy may be necessary. When the heart is damaged, preventive antibiotic therapy may be needed before any dental or surgical procedures for the rest of the individual's life. Damaged heart valves may require surgical repair (valvuloplasty).

The development of acute glomerulonephritis is treated symptomatically. High blood pressure is treated with antihypertensive drugs. Diuretics and a low-salt diet help reduce water retention. For severe complications, kidney dialysis may be needed.

Source: Medical Disability Advisor



Prognosis

The prognosis for treated strep throat is very good. Symptoms usually resolve within 3 to 4 days, although prescribed antibiotic therapy may need to continue for 10 days (Halsey). Residual effects are not expected in the vast majority of cases. Strep throat may recur in up to 30% of cases, most frequently when antibiotic treatment is delayed or individuals are noncompliant with antibiotic therapy (Brusch). Overall, antibiotic treatment can shorten the duration of the infection by approximately 16 hours and reduce the rate of complications (Choby).

Oral penicillin is nearly 100% effective for strep throat when given for 10 days; when given for 7 days, the success rate is 89%, and when given for 5 days, it is 50% effective (Brusch).

The predicted outcome for untreated or complicated strep throat varies. Significant long-term medical problems can develop, including rheumatic fever and glomerulonephritis. Although it is very rare, death from heart or kidney failure can occur.

Source: Medical Disability Advisor



Complications

Complications from a strep infection include sinus infection (sinusitis), middle ear infection (otitis media), mastoiditis, peritonsillar abscess, and lymph node involvement. Surgery may be necessary to drain abscesses that form in the tonsils or mastoid. Scarlet fever produces a rash caused by bacterial toxins. More serious complications include rheumatic fever or rheumatic heart disease that can damage the valves and muscle of the heart. Without antibiotic treatment, rheumatic fever occurs in 2.1% of cases; with treatment, it occurs in 0.3% of cases (Brusch).

Another complication is acute glomerulonephritis, an inflammation of the kidneys. In severe cases, kidney failure may occur. Streptococci may also involve the brain (streptococcal meningitis). Other relatively uncommon infections that may be caused by group A streptococci include arthritis; pneumonia; endocarditis; pockets of pus, most often in the lung (empyema); infection that rapidly destroys muscles and skin (necrotizing fasciitis); and a toxic shock-like syndrome.

Individuals with an internal prosthesis such as a knee or hip replacement must contact their physician immediately if a strep infection is suspected, as the infection may localize at the site of the prosthesis in the absence of immediate antibiotic therapy.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals should not return to work until at least for 24 hours after beginning antibiotics and their fever is gone (Halsey). If work involves strenuous exercise, workload should be reduced and then slowly increased as normal strength and endurance return.

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 have sore throat? Fever (over 100.4° F [38° C])?
  • Was individual's throat beefy red upon examination?
  • Were individual's tonsils enlarged?
  • Were white spots visible in individual's throat?
  • Were individual's lymph nodes enlarged?
  • Has diagnosis of streptococcal infection been confirmed by positive culture? Have other conditions that an cause pharyngitis been ruled out?
  • Was diagnosis or treatment delayed?
  • Has individual experienced complications such as sinusitis and otitis media?
  • If treatment was delayed, has individual experienced more serious complications (e.g., rheumatic fever, glomerulonephritis)?

Regarding treatment:

  • Is individual compliant with medication regimen?
  • If individual is unable to comply or incapable of complying with medication regimen, is there someone else in the household who could monitor or administer medication?
  • Has individual stopped taking antibiotics before completion of the prescribed course due to improvement of symptoms? Why?
  • If individual stopped taking antibiotics because of side effects, can an alternate antibiotic be prescribed?
  • If symptoms persist despite treatment, was culture and sensitivity performed to determine the appropriate antibiotics and to rule out antibiotic-resistant organisms?
  • If individual has an internal prosthesis was antibiotic therapy begun immediately to prevent localized infection?

Regarding prognosis:

  • How much longer than expected has illness persisted?
  • Does individual have an underlying condition, such as advanced age or a compromised immune system, which may affect recovery?
  • Would individual benefit from a different or longer course of antibiotics?
  • If individual has developed complications, is he or she responding to treatment?
  • Would individual benefit from consultation with a specialist (infectious disease specialist, cardiologist, nephrologist)?

Source: Medical Disability Advisor



References

Cited

Altamimi, S., et al. "Short Versus Standard Duration Antibiotic Therapy for Acute Streptococcal Pharyngitis in Children." Cochrane Database of Systematic Reviews 1 (2009): CD:004872. Medscape Today. Medscape. 4 Sep. 2009 <http://www.medscape.com/medline/abstract/19160243>.

Brusch, John. "Chapter 62: Streptococcal Pharyngitis." Conn’s Current Therapy. Eds. Robert E. Rakel and Edward T. Bope. 60th ed. Saunders Elsevier, 2009. MD Consult. Elsevier, Inc. <http://www.mdconsult.com/das/book/body/158120211-3/883937128/1621/124.html#4-u1.0-B978-1-4160-4435-2..50064-9_887>.

Choby, Beth A. "Diagnosis and Treatment of Streptococcal Pharyngitis ." American Family Physician 79 5 (2009): 383-390. PubMed. <http://www.ncbi.nlm.nih.gov/pubmed/19275067>.

Halsey, Eric. "Pharyngitis, Bacterial." eMedicine. Eds. Kenneth C. Earhart, et al. 19 May. 2009. Medscape. 4 Sep. 2009 <http://emedicine.medscape.com/article/225243-overview>.

Khan, Zartash Zafar, et al. "Streptococcus Group A Infections." eMedicine. Eds. Douglas A. Drevets, et al. 26 Jun. 2009. Medscape. 4 Sep. 2009 <http://emedicine.medscape.com/article/228936-overview>.

Source: Medical Disability Advisor






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