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.

Typhoid Fever


Related Terms

  • Enteric Fever
  • Paratyphoid
  • Typhoid

Specialists

  • Gastroenterologist
  • General Surgeon
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Length of disability may be influenced by the severity of infection at diagnosis, the presence of antibiotic-resistant bacteria, and the development of complications. Serious complications such as central nervous system (CNS) infection, intestinal perforation, or renal failure will require emergency medical care with a delayed recovery time.

Medical Codes

ICD-9-CM:
002.0 - Typhoid Fever, Infection, Any Site
002.1 - Paratyphoid Fever A
002.2 - Paratyphoid Fever B
002.3 - Paratyphoid Fever C
002.9 - Paratyphoid Fever, Unspecified

Overview

Typhoid fever is a serious, contagious bacterial infection caused by Salmonella typhi or less frequently by S. paratyphi. The organism enters through the gastrointestinal tract and spreads through the circulatory system (bacteremia), inflaming the lining (intestinal mucosa) of the small and large intestines. Severe cases can lead to delirium or coma, and may be life threatening.

Typhoid bacteria are shed in the feces and, less commonly, urine of infected individuals. Inadequate hand washing after defecation or urination can contaminate food and water supplies. Rarely, domestic animals may serve as a reservoir for paratyphoid. Flies may spread the disease from feces to food, causing epidemics in areas with poor sanitation practices. Hospital workers who do not follow the hospital's sterile procedures can be infected through the soiled linens of infected individuals.

Although some infected individuals do not develop actual symptoms, they are still capable of spreading the disease to others (carriers). In the US, many of the estimated 2,000 carriers are elderly women with chronic gallbladder disease.

Incidence and Prevalence: Now rare in the US (about 300 cases per year), typhoid fever is still common in areas with poor sanitation such as underdeveloped areas of Africa, Asia, and Latin America. Worldwide, each year there are 22 million cases of typhoid fever and 200,000 related deaths, and 6 million cases of paratyphoid fever (Newton).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk is especially high in travelers from the US to Africa, Asia, and Latin America where the disease is endemic. Travelers should be informed that typhoid immunization is not 100% effective.

Risk is also high in laboratory workers who handle S. typhi, and in immunocompromised individuals such as those receiving corticosteroids or who have diseases such as HIV/AIDS.

Source: Medical Disability Advisor



Diagnosis

History: Incubation period is 7-14 days. During the first week of the disease, the individual may report gradual onset of symptoms such as chills, high fever, headache, dry cough, sore throat, a generalized feeling of illness (malaise), loss of appetite (anorexia), abdominal pain and tenderness, joint pain (arthralgia), urinary tract symptoms, and constipation. Constipation may later turn into "pea soup" diarrhea. Fever plateaus after 7 to 10 days, leaving the individual exhausted.

Without treatment, during the second week individuals have persistent high fever, diarrhea or severe constipation, weight loss, and severe abdominal distention. In the course of the third week, delirium, stupor, or coma, and life-threatening complications may appear (typhoid state). During the fourth week individuals usually improve slowly, with gradual decrease of the fever (defervescence) and of the abdominal distension; symptoms and signs may return up to 2 weeks after fever has subsided.

Physical exam: The exam will typically reveal an inflamed throat and nasal mucosa. A fever will be present. In certain individuals, the pulse may be slow (relative bradycardia). Palpation may reveal an enlarged spleen (splenomegaly). In 10-20% of the cases, a rash (rose spots) will be found on the trunk during the second week of the disease; the rash usually clears in 2-5 days. The fever remains high for 7 to 10 days and will usually decline to normal during the fourth week. In severe cases, delirium or confusion may be noted. The infection may also cause pneumonia-like symptoms or symptoms similar to a urinary tract infection.

Tests: Blood, feces, and urine may be cultured for the presence of the Salmonella bacteria; cultures have 100% specificity. Polymerase chain reaction, if available, may be used as a diagnostic tool, with varying success. Blood tests may indicate moderate anemia, an elevated erythrocyte sedimentation rate (ESR), a low platelet count (thrombocytopenia) and a low white blood cell count (relative lymphopenia).

Source: Medical Disability Advisor



Treatment

Bacterial infection can usually be treated effectively with antibiotics. Treatment of typhoid fever can be complicated, however, by the presence of antibiotic-resistant bacteria. Since prompt treatment shortens the clinical course of the disease, and decreases the risk of complications and death, in the presence of a high suspicion of the diagnosis, for example, in an individual who has suggestive signs and symptoms and has returned from a country where the disease is endemic, broad-spectrum empiric antibiotics should be started immediately. The most commonly used drugs for empirical treatment are fluoroquinolones (such as ciprofloxacin) and cephalosporins (such as ceftriaxone); however, azithromycin is being increasingly used due to the emergence of multidrug-resistant strains. Definitive drug selection should be guided by susceptibility testing. Because the bacteria are often harbored in the biliary tree, gallbladder surgery (resection) may be used if antibiotic treatment is ineffective. Chronic carriers, if identified, are treated with an extended course of antibiotic therapy to eliminate the typhoid bacteria.

To prevent dehydration and electrolyte imbalance, fluids and electrolytes lost in diarrhea must be monitored and replaced.

In severe cases, corticosteroid drugs may be necessary to treat central nervous system symptoms such as seizures, shock, or delirium that have occurred as the result of high fever.

There may be a temporary requirement of parenteral nutrition. In the absence of abdominal distension or ileus, oral nutrition with a soft, nonbulky, digestible diet may be used. Perforation of the intestine will require emergency surgery. High doses of intravenous antibiotics may be used to correct systemic infection that results from perforation and the release of intestinal contents into the abdominal cavity.

Vaccines are now available for use in preventing typhoid fever in countries with widespread exposure and for travelers to high-risk areas or individuals exposed to drug-resistant S. typhi or S. paratyphi; however, as mentioned, immunization is not 100% effective (vaccines protect 50-80% of recipients).

Source: Medical Disability Advisor



Prognosis

With prompt and appropriate treatment, most individuals recover in 2 to 4 weeks. Complications can occur in those who are not treated or in whom treatment is delayed. Untreated and severe typhoid can result in coma or death. Relapses can occur in 5-10% of affected individuals, even with treatment.

Source: Medical Disability Advisor



Complications

Complications may include dehydration, intestinal perforation, hemorrhage, peritonitis, anemia, pneumonia, or inflammation of the liver or spleen. Bacteria in the bloodstream (bacteremia) can result in infection in the bones (osteomyelitis), joints (arthritis), kidneys (glomerulitis), heart valves (endocarditis), lining of the brain (meningitis), and genitals or the urinary tract. Muscle infection can result in abscesses. The infection could also affect the gallbladder and central nervous system.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Food handlers should be considered unfit for handling food until proven to be bacteria free. Individuals who suffer intestinal perforation should be given less strenuous work assignments during recovery from the surgery.

Risk: Because typhoid fever is highly contagious, work restrictions are necessary for infected individuals who work in food and beverage services or with immunocompromised individuals until cultures are negative for Salmonella bacteria. 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 length of time high fever is present, the severity of malaise, the speed of initiation of treatment, and whether treatment is complicated by antibiotic-resistant bacteria. Individuals with splenomegaly who normally perform heavy or very heavy work may need temporary reassignment to less strenuous job duties during recovery.

Tolerance: Tolerance of symptoms varies according to the individual and is dependent on whether arthralgia, abdominal pain, and diarrhea occur. Once the infection has resolved, tolerance is not expected to be a factor although relapses may occur in a small percentage of individuals. Individuals concerned over frequent diarrhea and fecal urgency may require ready access to bathroom facilities to remain productive during recovery.

Accommodations: Employers willing to accommodate activities as needed can have employees return to work earlier.

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:

  • Does individual have chills, high fever, headache, dry cough, sore throat, malaise, anorexia, abdominal pain and tenderness, arthralgia, and constipation? Did the constipation later turn into diarrhea?
  • Was the diagnosis of typhoid fever confirmed by the isolation of S. typhi in cultures?
  • Have other conditions with similar symptoms, such as tuberculosis, infective endocarditis, brucellosis, lymphoma, Q fever, viral hepatitis, malaria, and amebiasis, been ruled out?
  • Is there evidence of systemic infection or organ system involvement?
  • Would individual benefit from consultation with an infectious disease specialist?

Regarding treatment:

  • Was individual treated promptly with the appropriate antibiotic therapy?
  • Did the symptoms persist despite treatment? Were culture and sensitivity tests done to determine the possibility of antibiotic resistance? Has the antibiotic therapy been adjusted appropriately?
  • Is individual a chronic carrier? If so, was the course of antibiotic therapy extended appropriately?
  • Was there evidence of biliary involvement? Was surgery indicated?

Regarding prognosis:

  • Did adequate time elapse for recovery (2 to 4 weeks)?
  • Was there evidence that individual is infected with a drug-resistant strain?
  • Does individual have an underlying immune suppressive condition that may warrant lifelong suppressive therapy?
  • Has individual suffered any associated complications (i.e., intestinal perforation, peritonitis, hemorrhage, organ system involvement) that could impact recovery and prognosis? Have the complications been addressed in the treatment plan?
  • If individual is a carrier, has instruction been given regarding prevention of disease transmission?

Source: Medical Disability Advisor



References

Cited

Newton, Anna E. , Janell A. Routh, and Barbara E. Mahon. "Chapter 3: Infectious Diseases Related to Travel." CDC Health Information for International Travel (commonly called the Yellow Book). Centers for Disease Control and Prevention, 2016. Traveler's Health. Centers for Disease Control and Prevention. 24 Jul. 2015 <http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/typhoid-paratyphoid-fever>.

Source: Medical Disability Advisor






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