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.

Toxoplasmosis


Related Terms

  • Toxo

Differential Diagnosis

Specialists

  • Family Physician
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Any condition requiring immunosuppressant drugs
  • HIV/AIDS
  • Lymphoproliferative disorders

Factors Influencing Duration

The individual's age, the severity and extent of the disease, and the presence of a compromised immune system may influence length of disability.

Medical Codes

ICD-9-CM:
130.0 - Meningoencephalitis Due to Toxoplasmosis; Encephalitis Due to Acquired Toxoplasmosis
130.1 - Conjunctivitis Due to Toxoplasmosis
130.2 - Chorioretinitis Due to Toxoplasmosis; Focal retinochoroiditis Due to Acquired Toxoplasmosis
130.4 - Pneumonitis Due to Toxoplasmosis
130.5 - Hepatitis Due to Toxoplasmosis
130.7 - Toxoplasmosis of Other Unspecified Sites
130.8 - Multisystemic Disseminated Toxoplasmosis; Toxoplasmosis of Multiple Sites
130.9 - Toxoplasmosis, Unspecified

Overview

Toxoplasmosis is an infection caused by a single-celled protozoan organism called Toxoplasma gondii. Individuals infected with this organism may have no symptoms, a mild flu-like illness, or a more severe, sometimes fatal disease. Typically, healthy individuals have few or mild symptoms. Individuals with weakened immune systems (such as those with HIV/AIDS or cancer, transplant recipients, or those who take immunosuppressant drugs) have disease that is more severe.

The organism spreads through four routes. First, an individual may eat undercooked or raw meat containing Toxoplasma cysts, particularly pork, or anything contaminated with its juices.

Second, the organism may spread through hand-to-mouth contact after individuals handle anything contaminated with cat feces that contain Toxoplasma, such as cat litter, garden soil, or sand.

Third, a woman who becomes infected while pregnant or just before becoming pregnant can pass the infection to the fetus via the placenta. This is called congenital toxoplasmosis. The risk of vertical transmission increases with gestational age (14-17% in the first trimester, and 59-65% in the third trimester (Hokelek)). The disease is most severe when infection occurs in the first trimester. Fetuses infected later in pregnancy often experience no or mild effects. Infection in a woman at least 6-9 months before conception produces immunity to toxoplasmosis, and there is no transmission to the fetus.

The fourth route is the least common. The infection can be passed to an individual through an infected organ during transplantation, or by transfusion of contaminated blood.

Many people are already immune to toxoplasmosis because of earlier exposure to the organism. However, the infection remains latent in the body for life. People with a weakened immune system may become ill when a past infection becomes reactivated.

Incidence and Prevalence: In the US, about 225,000 cases of toxoplasmosis are reported each year, with 5000 hospitalizations and 750 deaths. Seropositivity rates between 10-15% are reported. About 10-20% of infected pregnant women develop symptoms (Hokelek). Toxoplasmosis is found worldwide but is more common in warm climates and at lower altitudes. El Salvador and France have a particularly high prevalence of infection. Up to 75% of the French population nationwide and 90% of the population of Paris have been infected with T. gondii. More than half the women of childbearing age in Central and South America, parts of Western Europe, and parts of Africa carry antibodies to the organism, indicating past infection (Hokelek).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Males and females are affected equally, and the percent of individuals infected increases with age. There are significant geographic differences in the prevalence of infection within the US. People living in warm, humid climates are more frequently infected.

Risk is higher in individuals with HIV/AIDS, those undergoing chemotherapy or receiving steroids and/or other immunosuppressive drugs, and in pregnant women.

Source: Medical Disability Advisor



Diagnosis

History: The disease can be differentiated by infection in the healthy individual, infection in the immunocompromised individual, and ocular (eye) infection.

In healthy individuals, over 80% have no symptoms (Hokelek). If symptoms are present, individuals may complain of fever, night sweats, a vague feeling of bodily discomfort (malaise), fatigue, headache, sore throat, muscle or joint pain (myalgias or arthralgias), swollen lymph glands (lymphadenopathy), and an occasional maculopapular rash.

In the immunocompromised individual, the symptoms are widespread. They usually affect the brain and spinal cord (central nervous system [CNS]) and can affect the lung, heart, and liver. Individuals complain of fever, headache, dry cough, shortness of breath (dyspnea), chest pain, weakness, seizures, a derangement of the sense of equilibrium, movement disorders, loss of sense of reality (psychosis), and reasoning and memory (cognitive) impairment.

Ocular toxoplasmosis usually results from a congenital condition. It typically is without symptoms until an individual is between 20 and 40 years of age. When disease does develop, an inflammatory condition in the eye (chorioretinitis) may occur, causing visual disturbances such as eye pain, tearing, sensitivity to light (photophobia), and blurring or island-like gaps in the visual field.

Physical exam: In healthy individuals who do complain of symptoms, lymph nodes in the neck may be swollen but not tender. Other signs may include fever, maculopapular rash, and muscle tenderness. Palpation may reveal enlarged spleen (splenomegaly) or liver (hepatomegaly).

Immunocompromised individuals may present with inflammation of the tissues surrounding the air passages (interstitial pneumonia) and inflammation of the heart (myocarditis). About half of all immunocompromised individuals have evidence of neurologic involvement, such as altered mental status, seizures, cranial nerve involvement, inflammation of the brain (encephalitis), or brain lesions.

A standard eye exam (ophthalmic exam) may reveal a whitish gray chorioretinal scar involving the vascular coat of the eye (choroid) and the retina. Inflammation may prevent a distinct view of the retina.

Tests: Diagnosis depends principally on blood (serologic) tests that detect antibodies against T. gondii. Tests for both IgG and IgM antibodies help determine if the antibodies are due to a new or an old infection. This information is especially important to a pregnant woman. Rarely, the diagnosis is made by finding the organism in blood or tissue in a microscopic examination.

Supportive tests in immunocompromised individuals include computed tomography (CT) scans and magnetic resonance imaging (MRI) of the head to determine the presence of lesions. Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are also helpful tools for imaging the brain.

Source: Medical Disability Advisor



Treatment

Healthy asymptomatic individuals who are not pregnant or those with chronic latent infections usually are not treated. When symptoms are severe or persistent, or if the individual is pregnant or immunocompromised, the infection usually is treated with a combination of antibiotic drugs, often pyrimethamine with sulfadiazine or clindamycin, plus folinic acid. Immunocompromised individuals require drug maintenance treatment for life.

Source: Medical Disability Advisor



Prognosis

Most individuals have a non-life-threatening, self-limited disease. Symptoms, if present, usually resolve within a few months. Rarely, they may last up to a year. In immunocompromised individuals, toxoplasmosis may be rapidly progressive, and recurrence of the infection is common. Complications may be fatal.

Treatment of infection during pregnancy does not lower transmission risk but may reduce the severity of congenital toxoplasmosis. It is possible for ocular toxoplasmosis to progress to glaucoma or blindness.

Source: Medical Disability Advisor



Rehabilitation

Toxoplasmosis warrants rehabilitation if the condition results in general weakness and/or affects the nervous system, including the brain. Once initial symptoms have stabilized and a physician determines no contraindications for physical activity, the rehabilitation professional initiates a gradual strengthening program. If necessary, the therapist may instruct the individual in respiratory exercises to help resolve breathing difficulties. Mild strengthening and endurance exercises such as calisthenics follow and should be performed 15 to 20 minutes, twice a day. The individual may then begin light aerobic activities such as brisk walking and low-resistance biking.

As endurance increases without shortness of breath, active upper and lower extremity exercises are initiated using very light resistance. This program progresses to more moderate resistance using free weights and/or weight machines. As the program continues, the frequency of the exercise sessions varies, depending on the individual's general health (e.g., individuals with a weakened immune systems may have a more significant symptoms). If tolerated, the individual performs strengthening exercises 3 times a week and aerobic activities on the nonstrengthening days of the program.

Balance exercises such as side stepping and walking with the eyes closed, with and without assistance, are useful in addressing any loss of balance and coordination resulting from toxoplasmosis. The rehabilitation program varies for individuals affected by toxoplasmosis. The intensity and progression of exercises depend on the affected body organs and the individual's overall health. For example, visual disturbance may require occupational therapy for dealing with decreased vision.

Source: Medical Disability Advisor



Complications

Complications may include glaucoma, blindness, interstitial pneumonia, myocarditis, encephalitis, partial paralysis, cranial nerve disturbances, seizures, and death.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Strenuous activity may need to be modified or restricted until physical stamina returns. Visual disturbances due to ocular toxoplasmosis may require accommodations dependent on their severity.

Pregnant women or women who are planning to become pregnant should be tested for toxoplasmosis if their work involves handling of raw meat, soil or sand, or cats. If a woman is already immune, no restrictions regarding meat, soil, or sand are needed. If a woman is not immune, she should avoid contact with these potential transmitters of infection. If alternate arrangements cannot be made, she should wear latex gloves while working outside, especially when working with sand or soil or when around cats. She should also wear latex gloves when handling raw meat.

Risk: Toxoplasmosis is not passed from one individual to another individual, so there is no risk of transmitting the infection to coworkers. In an immune compromised 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. A person with symptom onset within the last 24-48 hours will be at a more infectious state and should avoid working in settings with immune compromised individuals.

Capacity: Because the majority of individuals with toxoplasmosis infection are asymptomatic, accommodations are typically not needed. Individuals with ocular toxoplasmosis may require workstation modifications to reduce excess light and glare. Those whose duties involve driving may need temporary reassignment until eye inflammation resolves.

Tolerance: Tolerance is usually not an issue with toxoplasmosis unless the individual is immunocompromised, in which case tolerance will depend on symptoms associated with the underlying condition.

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:

  • Did individual have a history of exposure (i.e., eating undercooked meat or handling cat feces, cat litter, or garden soil) that may put him or her at risk for toxoplasmosis infection?
  • Is individual pregnant?
  • Did individual have flu-like symptoms (fever, fatigue, headache, sore throat, lymphadenopathy, or rash) that may be consistent with the diagnosis of toxoplasmosis?
  • Is individual immunocompromised?
  • Was there evidence of widespread involvement such as interstitial pneumonia, myocarditis, or neurological impairment?
  • Was the diagnosis confirmed with serologic tests?
  • Was the extent or severity of the infection determined?
  • If the diagnosis was uncertain, were other conditions with similar symptoms (e.g., cytomegalovirus, mononucleosis) ruled out?

Regarding treatment:

  • Was the treatment appropriate for the symptoms and underlying conditions?
  • Were antibiotic drugs indicated?
  • Did symptoms persist?

Regarding prognosis:

  • Did individual experience any recurrence of infection or complications that may have affected recovery and prognosis?

Source: Medical Disability Advisor



References

Cited

Hokelek, Murat. "Toxoplasmosis." eMedicine. 8 Sep. 2014. Medscape. 20 Jul. 2015 <http://emedicine.medscape.com/article/229969-overview#showall>.

Source: Medical Disability Advisor






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