Schedule of ratings—infectious diseases, immune disorders and nutritional deficiencies

Description Percentage

For active disease


After active disease has resolved, rate at 0 percent for infection. Rate any residual disability of infection within the appropriate body system.

Vibriosis (Cholera, Non-cholera):

Vibriosis is a potentially serious illness caused by pathogenic strains of the Vibrio genus of bacteria. There are two types of vibriosis: cholera and non-cholera. Vibrio cholerae strains O1 and O139 cause cholera, while other pathogenic strains of Vibrio cause non-cholera vibriosis.

Causes of Vibriosis

Vibrio bacteria are a natural part of the estuarine ecosystem, with higher levels present in warm water of moderate salinity. Vibrio bacteria can cause three types of infection: gastrointestinal, wound, and blood. Vibrio vulnificus and Vibrio parahaemolyticus are the most common species causing non-cholera vibriosis in the United States.

Symptoms of Vibriosis

Symptoms of non-cholera vibriosis can vary depending on the type of infection and may include watery diarrhea, abdominal cramps, nausea, vomiting, fever, and/or skin lesions. Symptoms of cholera include sudden onset of watery diarrhea, vomiting, and leg cramps. In severe cases, dehydration and electrolyte imbalances can occur, leading to shock and death.

Diagnosis of Vibriosis

Diagnosing vibriosis involves a thorough medical history and physical examination, as well as laboratory tests to confirm the presence of Vibrio bacteria. Stool samples or blood cultures may be collected and tested for the presence of Vibrio bacteria. In addition, imaging studies, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), may be performed to evaluate the extent of the infection.

Evaluate under the General Rating Formula

Note: Rate residuals of cholera and non-cholera vibrio infections, such as renal failure, skin, and musculoskeletal conditions, within the appropriate body system

Visceral leishmaniasis 

Visceral leishmaniasis, the most severe form of leishmaniasis also known as kala-azar, is a life-threatening disease caused by Leishmania parasites which are transmitted by female sandflies. Visceral leishmaniasis causes fever, weight loss, spleen and liver enlargement, and, if not treated, death. People with both visceral leishmaniasis and HIV are particularly difficult to cure. The disease is also linked to environmental changes such as deforestation, building of dams, irrigation schemes, and urbanization.


Visceral leishmaniasis is caused by: 

  • Leishmania parasites are transmitted through the bites of infected female phlebotomine sandflies 
  • Poor housing and domestic sanitary conditions may increase sandfly breeding and resting sites. 
  • Malnutrition increases the risk that an infection will progress to full-blown disease


The sign and symptoms include:

  • Fever
  • Weight loss (cachexia; wasting)
  • Hepatosplenomegaly (usually, the spleen is more prominent than the liver)
  • Pancytopenia, i.e., anemia, leukopenia, and thrombocytopenia
  • A high total protein level and a low albumin level, with hypergammaglobulinemia


Clinical: high clinical suspicion of disease is given to people from endemic areas with a persistent disease and unexplained fever accompanied by suggestive signs and symptoms. 

Laboratory: immunological and parasitological tests are performed.

The immunological test currently available at the primary level is the rapid immunochromatographic test based on recombinant rK39 antigen, but the indirect immunofluorescence (IIF) and enzyme immunoassay (ELISA) is also used in other levels of care. Parasitological tests are performed by detecting parasites in infected tissues, mainly in the bone marrow, through direct examination or isolation in culture (in vitro). Molecular tests detect Leishmania DNA through the PCR method.


Note 1: Continue a 100 percent evaluation beyond the cessation of treatment for active disease. Six months after discontinuance of such treatment, determine the appropriate disability rating by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.  Thereafter, rate under the appropriate body system any residual disability of infection, which includes, but is not limited to liver damage and bone marrow disease.

Note 2: Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.

Leprosy (Hansen's disease)

Leprosy is a chronic, progressive bacterial infection caused by the bacterium Mycobacterium leprae. It primarily affects the nerves of the extremities, the skin, the lining of the nose, and the upper respiratory tract. Leprosy is also known as Hansen’s disease.

Hansen’s disease produces skin ulcers, nerve damage, and muscle weakness. If it isn’t treated, it can cause severe disfigurement and significant disability. Hansen’s disease is common in many countries, especially those with tropical or subtropical climates. It’s not very common in the United States. The Centers for Disease Control and Prevention (CDC) reports that only 150 to 250 new cases are diagnosed in the United States each year.


There are three main types of leprosy, including:

Tuberculoid leprosy: Someone with this type of leprosy usually has mild symptoms, developing only a few sores. This is because of a good immune response. Tuberculoid leprosy is also called paucibacillary leprosy.

Lepromatous leprosy: People with this type of leprosy have widespread sores and lesions affecting nerves, skin and organs. With lepromatous leprosy, the immune response is poor and the disease is more contagious. Lepromatous leprosy is also called multibacillary leprosy.

Borderline leprosy: This type of leprosy involves symptoms of both tuberculoid and lepromatous leprosy. Borderline leprosy is also called dimorphus leprosy.


Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae (M. leprae). It isn’t clear exactly how leprosy is transmitted. When a person with leprosy coughs or sneezes, they may spread droplets containing the M. leprae bacteria that another person breathes in. Close physical contact with an infected person is necessary to transmit leprosy. It isn’t spread by casual contact with an infected person, like shaking hands, hugging, or sitting next to them on a bus or at a table during a meal. Pregnant mothers with leprosy can’t pass it to their unborn babies. It’s not transmitted by sexual contact either.

Signs and Symptoms

Symptoms mainly affect the skin, nerves, and mucous membranes (the soft, moist areas just inside the body’s openings). The disease can cause skin symptoms such as:

  • A large, discolored lesion on the chest of a person with Hansen’s disease.
  • Discolored patches of skin, usually flat, that may be numb and look faded (lighter than the skin around)
  • Growths (nodules) on the skin
  • Thick, stiff or dry skin
  • Painless ulcers on the soles of feet
  • Painless swelling or lumps on the face or earlobes
  • Loss of eyebrows or eyelashes
  • Symptoms caused by damage to the nerves are:
  • Numbness of affected areas of the skin
  • Muscle weakness or paralysis (especially in the hands and feet)
  • Enlarged nerves (especially those around the elbow and knee and in the sides of the neck)
  • Eye problems that may lead to blindness (when facial nerves are affected)

Symptoms caused by the disease in the mucous membranes are:

  • A stuffy nose
  • Nosebleeds

Since Hansen’s disease affects the nerves, loss of feeling or sensation can occur. When loss of sensation occurs, injuries such as burns may go unnoticed. Because you may not feel the pain that can warn you of harm to your body, take extra caution to ensure the affected parts of your body are not injured.

If left untreated, the signs of advanced leprosy can include:

  • Paralysis and crippling of hands and feet
  • Shortening of toes and fingers due to reabsorption
  • Chronic non-healing ulcers on the bottoms of the feet
  • Blindness
  • Loss of eyebrows
  • Nose disfigurement
  • Other complications that may sometimes occur are:
  • Painful or tender nerves
  • Redness and pain around the affected area
  • Burning sensation in the skin


If your healthcare provider thinks you might have Hansen's disease (leprosy), they’ll perform a skin biopsy. During this procedure, they’ll take a small sample of tissue and send it to a lab for analysis.

Note: Continue a 100 percent evaluation beyond the cessation of treatment for active disease. Six months after discontinuance of such treatment, determine the appropriate disability rating by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. Thereafter, rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, skin lesions, peripheral neuropathy, or amputations.


Malaria is a serious disease that spreads when you’re bitten by a mosquito infected by tiny parasites. When it bites, the mosquito injects malaria parasites into your bloodstream. Malaria is caused by the parasites, not by a virus or by a type of bacterium.

If it isn’t treated, malaria can cause severe health problems such as seizures, brain damage, trouble breathing, organ failure and death.

The disease is rare in the U.S., with about 2,000 cases per year. If you’re traveling to an area where malaria is common, talk to your healthcare provider about ways you can prevent being infected. People who are infected and travel to the U.S. can spread the disease if a mosquito bites them and then bites someone else.


Malaria is caused by the plasmodium parasite. The parasite spreads to humans through the bites of infected mosquitoes.


Signs and symptoms of malaria may include:

  • Fever
  • Chills
  • General feeling of discomfort
  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Abdominal pain
  • Muscle or joint pain
  • Fatigue
  • Rapid breathing
  • Rapid heart rate
  • Cough

Some people who have malaria experience cycles of malaria "attacks." An attack usually starts with shivering and chills, followed by a high fever, followed by sweating and a return to normal temperature.

Malaria signs and symptoms typically begin within a few weeks after being bitten by an infected mosquito. However, some types of malaria parasites can lie dormant in your body for up to a year.


Your doctor will be able to diagnose malaria. During your appointment, your doctor will review your health history, including any recent travel to tropical climates. A physical exam will also be performed.

Your doctor will be able to determine if you have an enlarged spleen or liver. If you have symptoms of malaria, your doctor may order additional blood tests to confirm your diagnosis.

These tests will show:

  • whether you have malaria
  • what type of malaria you have
  • if your infection is caused by a parasite that’s resistant to certain types of drugs
  • if the disease has caused anemia
  • if the disease has affected your vital organs

Note 1: The diagnosis of malaria, both initially and during relapse, depends on the identification of the malarial parasites in blood smears or other specific diagnostic laboratory tests such as antigen detection, immunologic (immunochromatographic) tests, and molecular testing such as polymerase chain reaction tests.

Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, liver or splenic damage, and central nervous system conditions.

Lymphatic filariasis, to include elephantiasis: 

Lymphatic filariasis, commonly known as elephantiasis, is a painful and profoundly disfiguring disease. It is caused by infection with parasites classified as nematodes (roundworms) of the family Filariodidea that are transmitted through the bites of infected mosquitos. Mosquito-transmitted larvae are deposited on the skin from where they can enter the body. The larvae then migrate to the lymphatic vessels where they develop into adult worms, thus continuing a cycle of transmission.

In communities where filariasis is transmitted, all ages are affected. While the infection may be acquired during childhood, its visible manifestations such as limbs oedema may occur later in life, causing temporary or permanent disability. In endemic countries, lymphatic filariasis has a major social and economic impact.

Cause and transmission

Lymphatic filariasis is caused by infection with parasites classified as nematodes (roundworms) of the family Filariodidea. There are 3 types of these thread-like filarial worms:

  • Wuchereria bancrofti, which is responsible for 90% of the cases
  • Brugia malayi, which causes most of the remainder of the cases
  • Brugia timori, which also causes the disease.

Adult worms nest in the lymphatic vessels and disrupt the normal function of the lymphatic system. The worms can live for approximately 6–8 years and, during their lifetime, produce millions of microfilariae (immature larvae) that circulate in the blood.

Mosquitoes are infected with microfilariae by ingesting blood when biting an infected host. Microfilariae mature into infective larvae within the mosquito. When infected mosquitoes bite people, mature parasite larvae are deposited on the skin from where they can enter the body. The larvae then migrate to the lymphatic vessels where they develop into adult worms, thus continuing the cycle of transmission.

Lymphatic filariasis is transmitted by different types of mosquitoes, for example by the Culex mosquito, widespread across urban and semi-urban areas, Anopheles, mainly found in rural areas, and Aedes, mainly in endemic islands in the Pacific.


About two in every three people who have lymphatic filariasis don’t have severe symptoms. But filariasis usually leads to a weakened immune system.

Some people may experience:

  • Inflammation: an overactivated immune system.
  • Lymphedema: fluid buildup in your lymphatic system.
  • Hydrocele: swelling and fluid buildup in the scrotum.
  • Edema: swelling and fluid buildup in your arms, legs, breasts and female genitals (vulva).


The standard method for diagnosing active infection is the identification of microfilariae in a blood smear by microscopic examination. The microfilariae that cause lymphatic filariasis circulate in the blood at night (called nocturnal periodicity). Blood collection should be done at night to coincide with the appearance of the microfilariae, and a thick smear should be made and stained with Giemsa or hematoxylin and eosin. For increased sensitivity, concentration techniques can be used.

Serologic techniques provide an alternative to microscopic detection of microfilariae for the diagnosis of lymphatic filariasis. Patients with active filarial infection typically have elevated levels of antifilarial IgG4 in the blood and these can be detected using routine assays.

Because lymphedema may develop many years after infection, lab tests are most likely to be negative with these patients.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, epididymitis, lymphangitis, lymphatic obstruction, or lymphedema affecting extremities, genitals, and/or breasts.


Bartonellosis is a group of infectious diseases caused by Bartonella bacteria. There are 22 known species of Bartonella bacteria, of which 15 can cause Bartonellosis. They can spread from animals to humans through carriers like fleas, lice, or sand flies. They can also spread if a pet or wild animal bites or scratches you.


Bartonella species may be transmitted by contact with flea and louse feces, ticks or biting flies, or by the scratch or bite of an infected animal, most often a flea-infested cat.  Bartonella species DNA have been found in several arthropod vectors in the United States, including cat fleas (Ctenocephalides felis) and ticks (Ixodes scapularis, Ixodes pacificus). Suspected transmission of Bartonella species following the bite or scratch of wild animals, such as groundhogs, squirrels and coyotes has also been documented.

Research suggests that people who live and work with animals, especially veterinary workers, have the highest risk of Bartonella infection.


  • fever
  • skin manifestations (cat-scratch disease [CSD])
  • lymphadenopathy (CSD, Oroya fever)
  • episodic abdominal pain (CSD)
  • gastrointestinal symptoms
  • bone and joint pain (trench fever)
  • severe pallor (Oroya fever)
  • hepatosplenomegaly (Oroya fever)


Diagnosis cannot be made purely on clinical grounds, requiring laboratory confirmation as clinical signs and symptoms may be nonspecific. Serological tests exist for Bartonella infections; most commonly employed are immunofluorescent fluorescent antibody (IFA) assays for both IgM and IgG antibodies. However, false negatives occur. In a study positive titers were found in only 30 percent of patients in whom Bartonella infection was confirmed by PCR and DNA sequencing. Cross reactions may occur with antibodies to Coxiella burnetti, chlamydia, and certain rickettsial infections. Western blot tests appear to have greater specificity.

The DNA of various Bartonella species can also be amplified by polymerase chain reaction (PCR) in blood, spinal fluid, and tissue; given the cross-reactivity of the Bartonellaantibody tests, PCR may be the most reliable and useful test for Bartonella infection. Culture of Bartonella organisms is possible, but the bacteria are generally slow-growing in the laboratory. Culture using standard medium is insensitive. Also important to note, animal studies reveal that Bartonella infection is not always pathogenetic, i.e. a high percentage of healthy individuals may test positive serologically but not recall a prior Bartonella-like infection.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, endocarditis or skin lesions.


Plague is an infectious disease caused by Yersinia pestis bacteria, usually found in small mammals and their fleas. The disease is transmitted between animals via their fleas and, as it is a zoonotic bacterium, it can also transmit from animals to humans.

Humans can be contaminated by the bite of infected fleas, through direct contact with infected materials, or by inhalation. Plague can be a very severe disease in people, particularly in its septicaemic and pneumonic forms, with a case-fatality ratio of 30% - 100% if left untreated.

Types of plague

There are three basic forms of plague:

Bubonic plague

The most common form of the plague is bubonic plague. It’s usually spread by the bite of an infected flea. In very rare cases, you can get the bacteria from material that has come into contact with a person who has the infection.

Bubonic plague infects your lymphatic system (a part of the immune system), causing inflammation in your lymph nodes. Untreated, it can move into the blood (causing septicemic plague) or to the lungs (causing pneumonic plague).

Septicemic plague

When the bacteria enter the bloodstream directly and multiply there, it’s known as septicemic plague. When they’re left untreated, both bubonic and pneumonic plague can lead to septicemic plague.

Pneumonic plague

When the bacteria spread to or first infect the lungs, it’s known as pneumonic plague — the most lethal form of the disease if untreated.

When someone with pneumonic plague coughs, the bacteria from their lungs are expelled into the air. Other people who breathe that air can also develop this highly contagious form of plague, which can lead to an epidemic.

While pneumonic plague can be fatal if left untreated, recovery rates are typically very high if treated within the first 24 hours when symptoms present themselves.

Pneumonic plague is the only form of the plague that can be transmitted from person to person.


Transmission of Y. pestis to an uninfected individual is possible by any of the following means:

  • droplet contact: coughing or sneezing on another person
  • direct physical contact: touching an infected person, including sexual contact
  • indirect contact: usually by touching soil contamination or a contaminated surface
  • airborne transmission: if the microorganism can remain in the air for long periods
  • fecal-oral transmission: usually from contaminated food or water sources
  • vector borne transmission: carried by insects or other animals.


Plague is divided into three main types i.e.,  bubonic, septicemic and pneumonic, depending on which part of your body is involved. Signs and symptoms vary depending on the type of plague.

Bubonic plague

Bubonic plague is the most common variety of the disease. It's named after the swollen lymph nodes (buboes) that typically develop in the first week after you become infected. Buboes may be:

  • Situated in the groin, armpit or neck
  • About the size of a chicken egg
  • Tender and firm to the touch

Other bubonic plague signs and symptoms may include:

  • Sudden onset of fever and chills
  • Headache
  • Fatigue or malaise
  • Muscle aches
  • Septicemic plague

Septicemic plague occurs when plague bacteria multiply in your bloodstream. Signs and symptoms include:

  • Fever and chills
  • Extreme weakness
  • Abdominal pain, diarrhea and vomiting
  • Bleeding from your mouth, nose or rectum, or under your skin
  • Shock
  • Blackening and death of tissue (gangrene) in your extremities, most commonly your fingers, toes and nose

Pneumonic plague

Pneumonic plague affects the lungs. It's the least common variety of plague but the most dangerous, because it can be spread from person to person via cough droplets. Signs and symptoms can begin within a few hours after infection, and may include:

  • Cough, with bloody mucus (sputum)
  • Difficulty breathing
  • Nausea and vomiting
  • High fever
  • Headache
  • Weakness
  • Chest pain

Pneumonic plague progresses rapidly and may cause respiratory failure and shock within two days of infection. Pneumonic plague needs to be treated with antibiotics within a day after signs and symptoms first appear, or the infection is likely to be fatal.


To diagnose plague, your healthcare provider will take a sample of your blood, your spit (mucus or phlegm) or fluid from a lymph node. They’ll send your sample to a lab to look for signs of Y. pestis bacterium.

Note: Rate under the appropriate body system any residual disability of infection.

Relapsing Fever 

As the name implies, relapsing fever is a condition characterized by recurrent acute episodes of fever followed by intervening afebrile periods. It is an arthropod-borne infection caused by spirochetes of the Borrelia genus. Spirochetes are a unique species of bacteria that also cause syphilis, Lyme disease, and leptospirosis.  The fever relapses result from spirochetal antigenic variation. Relapsing fever, if untreated, may be fatal.

Relapsing fever is an arthropod-borne infection spread by lice (Pediculus humanus) and ticks (Ornithodoros species). Two main forms of this infection exist: tick borne relapsing fever (TBRF) and louse-borne relapsing fever (LBRF)


Louse-borne relapsing fever

Along with Rickettsia prowazekii and Bartonella quintana, Borrelia recurrentis is one of three pathogens of which the body louse (Pediculus humanus humanus) is a vector. Louse-borne relapsing fever is more severe than the tick-borne variety.

Louse-borne relapsing fever occurs in epidemics amid poor living conditions, famine and war in the developing world. It is currently prevalent in Ethiopia and Sudan.

Mortality rate is 1% with treatment and 30–70% without treatment. Poor prognostic signs include severe jaundice, severe change in mental status, severe bleeding and a prolonged QT interval on ECG

Lice that feed on infected humans acquire the Borrelia organisms that then multiply in the gut of the louse. When an infected louse feeds on an uninfected human, the organism gains access when the victim crushes the louse or scratches the area where the louse is feeding. B. recurrentis infects the person via mucous membranes and then invades the bloodstream. No non-human, animal reservoir exists.

Tick-borne relapsing fever

Tick-borne relapsing fever is found primarily in Africa, Spain, Saudi Arabia, Asia, and certain areas of Canada and the western United States. Other relapsing infections are acquired from other Borrelia species, which can be spread from rodents, and serve as a reservoir for the infection, by a tick vector.

  • Borrelia crocidurae occurs in Egypt, Mali, Senegal, Tunisia; vectors – Carios erraticus, Ornithodoros sonrai; animal host – shrew (Crocidura stampflii)
  • Borrelia duttoni, transmitted by the soft-bodied African tick Ornithodoros moubata, is responsible for the relapsing fever found in central, eastern, and southern Africa.
  • Borrelia hermsii
  • Borrelia hispanica
  • Borrelia miyamotoi
  • Borrelia parkeri
  • Borrelia turicatae
  • Borrelia persica

B. hermsii and B. recurrentis cause very similar diseases. However, one or two relapses are common with the disease associated with B. hermsii, which is also the most common cause of relapsing disease in the United States.


It’ll take about a week for symptoms to appear after you’re bitten. The main one is a high fever that comes and goes. The fever usually lasts for 3 to 5 days, goes away for 5 to 7 days, and then comes back. If the infection isn’t treated, this cycle repeats itself.

At the end of each feverish period, your temperature may jump. It can reach 106.7 F. This lasts for 10 to 30 minutes. Then your temperature drops, and you sweat heavily.

Other symptoms of TBRF include:

  • Headache
  • Muscle or joint pain
  • Chills
  • Vomiting
  • Stomach pain
  • Confusion
  • Coughing
  • Neck or eye pain
  • Diarrhea
  • Rash


Relapsing fever should be suspected if someone coming from a high-risk area has repeated episodes of fever. This is largely true if the fever is followed by a "crisis" stage, and if the person may have been exposed to lice or soft-bodied ticks.

Tests that may be done include:

  • Blood smear to determine the cause of the infection
  • Blood antibody tests (sometimes used, but their usefulness is limited)

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, liver or spleen damage, iritis, uveitis, or central nervous system involvement.

Rheumatic fever

Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.

Rheumatic fever most often affects children ages 5 to 15. But it can develop in younger children and adults. 

Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatment can ease pain, reduce damage from inflammation and prevent a recurrence of rheumatic fever.


Rheumatic fever is an overreaction of your body’s immune system that causes it to fight healthy tissues. An untreated strep throat or scarlet fever infection can trigger this overreaction. It happens when group A streptococcus infections are not adequately treated with antibiotics.

When your body’s defenses (antibodies) begin to fight back, the reaction can damage healthy tissues and organs instead of the bacteria.

Signs and Symptoms 

Symptoms of strep throat include:

  • sore throat
  • headache
  • swollen, tender lymph nodes
  • trouble swallowing
  • nausea and vomiting
  • red skin rash
  • high temperature
  • swollen tonsils
  • abdominal pain

Signs and symptoms generally develop 2 to 4 weeks after a streptococcal infection. Some individuals will experience just one or two of the following symptoms, but others may experience most of them:

  • fatigue
  • rapid heart rate
  • decreased ability to exercise
  • joint pain and swelling
  • fever
  • splotchy rash
  • uncontrollable twitching and movements

Arthritis, or pain and swelling in the joints, affects 75 percent of patients. It normally starts in the larger joints, such as the knees, ankles, wrists, and elbows, before moving to other joints. This inflammation normally resolves within 4-6 weeks, without causing permanent damage.

Inflammation of the heart can lead to chest pain, palpitations, a sensation that the heart is fluttering or pounding hard, panting, and shortness of breath, and fatigue.

On average, around 50 percent of patients develop carditis or valvulitis, a potentially fatal inflammation of the heart that can have serious, long-term effects. Younger children are more susceptible.

Inflammation of the nerves can lead to symptoms of Sydenham’s chorea, including:

  • chorea, the uncontrollable jerking of knees, elbows, wrists, and ankles
  • inappropriate crying or laughing
  • irritability and moodiness
  • difficulty controlling fine hand movements
  • problems with balance

Symptoms usually pass within a few months but can last up to 2 years. They are not normally permanent.

Other symptoms include a red, blotchy, skin rash, which appears in 1 in 10 cases. Less common are nosebleeds, abdominal pain, bumps and lumps, or nodules, under the skin, and a high fever over 102 degrees Fahrenheit.

The inflammation may also lead to headache, sweating, vomiting, and weight loss.


There is no single test used to diagnose rheumatic fever. Instead, doctors can look for signs of illness, check the patient’s medical history, and use many tests, including:

  • A throat swab to look for a group A strep infection
  • A blood test to look for antibodies to see if the patient recently had a group A strep infection
  • Electrocardiogram or EKG (a test of how well the heart is working)
  • Echocardiography or echo (a test that creates a movie of the heart muscle working)

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, heart damage

Syphilis, and other treponemal infections 

Syphilis is a chronic bacterial infection that can be transmitted through sexual contact. Syphilis is caused by a type of bacteria known as Treponema pallidum.

People have been getting, treating, and surviving syphilis for hundreds of years. In fact, treatments are so well established that at one point it was thought possible to eradicate syphilis completely. Despite this, rates of syphilis are actually rising among several demographics in the United States.

In 2020, 133,945 new cases of syphilis (all stages) were reported in the United States, according to the Centers for Disease Control and Prevention (CDC). Syphilis in people with vaginas is rising slightly more than people with penises, though both groups are seeing an uptick in cases overall.

Syphilis can be challenging to diagnose. Someone can have it without showing any symptoms for years. However, the earlier syphilis is discovered, the better. Syphilis that remains untreated for a long time can cause major damage to important organs, such as the heart and the brain.

Other treponemal infections

Infection with other T. pallidum subspecies (i.e., T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum) is acquired through contact with infected skin. These may result in a simple rash, but may progress and cause disfiguring skin lesions. Unlike syphilis, these infections are not considered sexually transmitted. Long-term infection can lead to deformation of bone and nasopharyngeal tissue. Infection with any of these subspecies can also cause seroreactivity for treponemal and nontreponemal tests used for diagnosis of syphilis; therefore, it is important to obtain a history of sexual and nonsexual exposures and consider T. pallidum subspecies in persons from areas where these infections are endemic.

Cause of Syphilis

Syphilis is caused by the bacteriaTreponema pallidum. You get it through direct contact with a syphilis sore on someone else’s body. This usually  happens during sexual activity, but the bacteria can also get into your body through cuts on your skin or through your mucous membranes.

Syphilis can’t be spread by toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

Symptoms of Syphilis 

Some people with syphilis have no symptoms, so you may not know you have it unless you get tested. There are 4 stages of syphilis infection: primary, secondary, latent and tertiary.

The signs and symptoms of syphilis depend on the stage of disease.

Primary syphilis occurs 3 or 4 weeks after infection (although it can take up to 90 days for the sore to appear). Symptoms may include a single painless sore usually about a centimetre big at the site where the infection entered the body — such as on the penis, vagina, cervix, mouth or anus. There may also be swollen lymph nodes.

The sore, or sometimes multiple sores, can go unnoticed because it is usually painless and may be hidden from view in areas such as the back of the throat, vagina or anus.

These sores usually go away by themselves after 3 to 6 weeks, even with no treatment. However, even though the sore heals, if you haven’t been treated, you are still infectious and can pass it on to others.

Secondary syphilis can occur 7 to 10 weeks after the initial infection. Symptoms can last for 6 months or more and may include:

  • a red rash on the palms, soles, chest or back
  • fever
  • enlarged glands in the armpits and groin
  • sore throat
  • hair loss
  • weight loss
  • headaches
  • pain in the bones, muscles and joints
  • tiredness
  • ulcers in the mouth, nasal cavity or genitals
  • neurological symptoms

Latent (sleeping) syphilis generally has no symptoms and it is only picked up on blood tests. If syphilis is not treated at this stage, it can remain latent or develop into tertiary syphilis. Latent syphilis is infectious within the first 12 to 24 months.

Tertiary syphilis can appear anywhere from 5 to 20 years after primary infection. At this stage, the bacteria can damage almost any part of the body including the heart, brain, spinal cord, eyes and bones, resulting in heart disease, mental illness, blindness, deafness and neurological problems.



Syphilis can be diagnosed by testing samples of:

Blood: Blood tests can confirm the presence of antibodies that the body produces to fight infection. The antibodies to the syphilis-causing bacteria remain in your body for years, so the test can be used to determine a current or past infection.

Cerebrospinal fluid: If it's suspected that you have nervous system complications of syphilis, your doctor may also suggest collecting a sample of cerebrospinal fluid through a lumbar puncture.

Through the Centers for Disease Control and Prevention, your local health department offers partner services, which will help you notify your sexual partners that they may be infected. Your partners can be tested and treated, limiting the spread of syphilis.

               Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, diseases of the nervous system, vascular system, eyes, or ears (see DC 7004, DC 8013, DC 8014, DC 8015, and DC 9301).

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, diseases of the nervous system, vascular system, eyes, or ears (see DC 7004, DC 8013, DC 8014, DC 8015, and DC 9301).

Tuberculosis, miliary

Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds, thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.

Cause of Miliary Tuberculosis 

Miliary tuberculosis is a potentially life-threatening type of tuberculosis that occurs when a large number of the bacteria travel through the bloodstream and spread throughout the body. is a contagious infection caused by the airborne bacteria Mycobacterium tuberculosis.


The symptoms of miliary TB are very general. They can include:

  • a fever that goes on for several weeks and may be worse in the evening
  • chills
  • dry cough that may occasionally be bloody
  • fatigue
  • weakness
  • shortness of breath that increases with time
  • poor appetite
  • weight loss
  • night sweats
  • just not feeling well in general

If other organs besides your lungs are infected, these organs may stop working properly. This can cause other symptoms, such as low levels of red blood cells if your bone marrow is affected or a characteristic rash if your skin is involved.


  • Examination and culture of a sample from the infected area
  • When available, nucleic acid amplification tests
  • Tuberculin skin test or blood tests to detect tuberculosis
  • A chest x-ray

Diagnosis of miliary tuberculosis is similar to the diagnosis of pulmonary tuberculosis. Samples of infected fluids may be examined under a microscope and/or sent to a laboratory to be grown (cultured) and tested. Samples may be:

  • Blood
  • Cerebrospinal fluid, obtained by spinal tap (lumbar puncture)
  • Urine
  • Fluid from the space between the two layers of the membrane that surrounds the lungs (pleura)
  • Fluid from the space between the two layers of the membrane that surrounds the heart (pericardium)
  • Joint fluid
  • Bone marrow

Mycobacterium tuberculosis can sometimes be identified by doing nucleic acid amplification tests (NAATs) on certain types of samples. 

Note 1: Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.

Note 2: Rate under the appropriate body system any residual disability of infection which includes, but is not limited to, skin conditions and conditions of the respiratory, central nervous, musculoskeletal, ocular, gastrointestinal, and genitourinary systems and those residuals listed in §4.88c.

Nontuberculosis mycobacterium infection 

Nontuberculous mycobacteria (NTM) are bacteria naturally found in dust, soil and water. These organisms are related to the bacteria that cause tuberculosis, but NTM don’t cause tuberculosis.

Everyone breathes in NTM, but only some people get sick. You’re most likely to get sick from NTM if you have other health problems or a weakened immune system. There are more than approximately 200 types of NTM mycobacteria identified. Most of the pulmonary (lung) NTM infections in the U.S. are caused by the most common type, Mycobacterium avium complex (or MAC).

NTM can cause infections in different parts of the body. These infections occur most often in the lungs, but can also develop in other organs. It’s rarely contagious, meaning that NTM infections are not spread from person to person, unlike other types of respiratory infections.

NTM infections have been identified in healthcare settings, such as hospitals. The bacteria have been associated with catheter-associated bloodstream infections and other device- and water-related infections.

If you have a mild NTM infection, you may not need treatment. Severe infections cause chronic (long-term) health problems such as persistent cough and breathing problems that can affect your quality of life. People with these infections may need ongoing treatment for years. NTM infections can be localized (limited to one part of the body) or disseminated (spread throughout the body)


NTM are a family of common bacteria found in water and soil. We all come into contact with NTM bacteria in our daily lives. There are lots of different species of NTM. Some are more likely to cause problems than others.


NTMs can cause infections in a wide variety of body sites, most commonly the lungs and in the following areas:

  • Skin and soft tissue (typically following surgery, trauma, injection of medications or other substances)
  • Device associated infections (e.g., central line associated bloodstream infection, exit site infections, pacemaker pocket site infections, etc.)
  • Lymph nodes (most commonly in children)
  • Blood or other usually sterile locations in the body (disseminated) (most commonly in immunocompromised patients, such as those with HIV or AIDS, but may also be due to invasive medical devices or procedures)

Symptoms can be vague and nonspecific, such as:

  • Fever
  • Weight loss
  • Night sweats
  • Decreased appetite
  • Loss of energy

Other symptoms depend on the site of infection and can include cough, shortness of breath, blood in the sputum, and rashes.


A doctor tests you for an NTM infection. Symptoms of NTM infections are similar to other conditions such as pneumonia. Your doctor may use several tests to rule out these conditions and confirm that nontuberculous mycobacteria are present.

If your doctor suspects a lung infection, tests to confirm the diagnosis may include:

  • Sputum culture
  • Bronchoscopy
  • Imaging tests

If your doctor suspects an NTM infection in another part of the body, you may have tests such as:

  • Blood culture
  • Biopsy

Note 1: Continue the rating of 100 percent for the duration of treatment for active disease followed by a mandatory VA exam. If there is no relapse, rate on residuals. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

Note 2: Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.

Note 3: Rate under the appropriate body system any residual disability of infection which includes, but is not limited to, skin conditions and conditions of the respiratory, central nervous, musculoskeletal, ocular, gastrointestinal, and genitourinary systems and those residuals listed in §4.88c.


Avitaminosis is a group of diseases that is due to a lack of one or more than one vitamin. The diseases in the Avitaminosis group are pellagra, beriberi, scurvy, rickets, and night blindness. 

  • Pellagra is due to a lack of niacin or vitamin B3. 
  • Beriberi is a condition caused by a deficiency of vitamin B1. 
  • Scurvy is caused by a long-term deficiency of vitamin C or ascorbic acid. 
  • Rickets is due to a lack of vitamin D. 
  • Night blindness is often caused by an insufficient amount of vitamin A.
  • Avitaminosis is often due to a lack of nutrition or unavailability of food with certain vitamins.


Avitaminosis (vitamin lack) may be encountered when:

  •  there are increased losses of vitamins such as occur with chronic severe diarrhea
  • excessive sweating
  • when there are increased requirements for vitamins during periods of rapid growth, especially during childhood and pregnancy. 
  • Fever and the endocrine disorder hyperthyroidism are two additional examples of conditions that require higher than the usual levels of vitamin intake. 

Unless the diet is adjusted to the increased requirements, deficiencies may develop. Lastly, artificial manipulation of the body and its natural metabolic pathways, as by certain surgical procedures or the administration of various drugs, can lead to avitaminoses.

Signs and Symptoms 

Following are some common symptoms of Avitaminosis:

  • Fatigue
  • Shortness of breath
  • Dizziness
  • Pale or yellowish skin
  • Irregular heartbeats
  • Weight loss
  • Numbness or tingling in the hands and feet
  • Muscle weakness


To help diagnose vitamin deficiency anemias, you might have blood tests that check for: The number and appearance of red blood cells. The amount of vitamin B-12 and folate in the blood. The presence of antibodies to intrinsic factor, which indicates pernicious anemia.


Pellagra is a disease caused by a deficiency of niacin, otherwise known as vitamin B3. It’s a form of malnutrition specifically, micronutrient undernutrition. Niacin is crucial to cell functioning throughout your body, and the lack of it shows up in symptoms throughout your body, including your skin, mouth, bowels and brain. If left untreated, pellagra can cause lasting damage to your nervous system and even death.

Niacin is found in many food sources, and most people who eat a balanced diet get enough of it. But primary pellagra, from inadequate dietary intake, is still a significant problem in impoverished and food-limited populations. In the industrialized world, niacin deficiency is more likely to occur from secondary causes, from health conditions or substances that prevent your body from absorbing or using niacin.


Pellagra is caused by having too little niacin or tryptophan in the diet. It can also occur if the body fails to absorb these nutrients.

Pellagra may also develop due to:

  • Gastrointestinal diseases
  • Weight loss (bariatric) surgery
  • Anorexia
  • Excessive alcohol use
  • Carcinoid syndrome (group of symptoms associated with tumors of the small intestine, colon, appendix, and bronchial tubes in the lungs)
  • Certain medicines, such as isoniazid, 5-fluorouracil, 6-mercaptopurine, pyrazinamide, hydantoin, ethionamide, phenobarbital, azathioprine, and chloramphenicol.


The main symptoms of pellagra are dermatitis, dementia, and diarrhea. This is because niacin deficiency is most noticeable in body parts with high rates of cell turnover, such as your skin or gastrointestinal tract.

Dermatitis related to pellagra usually causes a rash on the face, lips, feet, or hands. In some people, dermatitis forms around the neck, a symptom known as Casal necklace.

Additional dermatitis symptoms include:

  • red, flaky skin
  • areas of discoloration, ranging from red to brown
  • thick, crusty, scaly, or cracked skin
  • itchy, burning patches of skin

In some cases, the neurological signs of pellagra appear early on, but they’re often hard to identify. As the disease progresses, possible dementia symptoms include:

  • apathy
  • depression
  • confusion, irritability, or mood changes
  • headaches
  • restlessness or anxiety
  • disorientation or delusions

Other possible pellagra symptoms include:

  • sores on the lips, tongue, or gums
  • decreased appetite
  • trouble eating and drinking
  • nausea and vomiting


Your health care provider will perform a physical exam. You will be asked about the foods you eat.

Tests that may be done include urine tests to check if your body has enough niacin. Blood tests may also be done.


Brucellosis is an infectious disease caused by a type of bacteria called Brucella. The bacteria can spread from animals to humans. There are several different strains of Brucella bacteria. Some types are seen in cows. Others occur in dogs, pigs, sheep, goats, and camels. Recently, scientists have seen new strains in the red fox and certain marine animals, including seals. Brucella in animals cannot be cured.


Several types of Brucella bacteria cause brucellosis, including B. abortus, B. canis, B. meliensis and B. suis. Animals carry Brucella, including:

  • Cattle
  • Goats
  • Pigs
  • Deer
  • Moose
  • Elk
  • Sheep
  • Dogs
  • Camels

Signs and Symptoms

Brucellosis can cause a range of signs and symptoms, some of which may present for prolonged periods of time.

Initial symptoms can include:

  • fever
  • sweats
  • malaise
  • anorexia
  • headache
  • pain in muscles, joint, and/or back
  • fatigue

Some signs and symptoms may persist for longer periods of time. Others may never go away or reoccur. These can include:

  • recurrent fevers
  • arthritis
  • swelling of the testicle and scrotum area
  • swelling of the heart (endocarditis)
  • neurologic symptoms (in up to 5% of all cases)
  • chronic fatigue
  • depression
  • swelling of the liver and/or spleen


Doctors usually confirm a diagnosis of brucellosis by testing blood or bone marrow for the brucella bacteria or by testing blood for antibodies to the bacteria. To help detect complications of brucellosis, your doctor may order additional tests, including:

X-rays: X-rays can reveal changes in your bones and joints.

Computerized tomography (CT) scan or magnetic resonance imaging (MRI): These imaging tests help identify inflammation or abscesses in the brain or other tissues.

Cerebrospinal fluid culture: This checks a small sample of the fluid that surrounds your brain and spinal cord for infections such as meningitis and encephalitis.

Echocardiography: This test uses sound waves to create images of your heart to check for signs of infection or damage to your heart.

Note 1: Culture, serologic testing, or both must confirm the initial diagnosis and recurrence of active infection.

Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, meningitis, liver, spleen and musculoskeletal conditions.

Rickettsial, ehrlichia, and anaplasma infections: 


The bite of a Gulf Coast tick causes this condition. It’s also called Rickettsia parkeri rickettsiosis. This is a form of spotted fever, which means it commonly causes a rash or “spots.” But rickettsiosis is less serious than Rocky Mountain spotted fever.


The two diseases share symptoms such as fever, headache, joint pain, and muscle aches. But with rickettsiosis, there’s usually a scab, or “eschar,” where the tick was attached. Doctors can treat it with the antibiotic doxycycline.


If a black-legged tick, or western black-legged tick, bites a rodent infected with the rickettsial bacteria Anaplasma phagocytophilum, and then bites you, it can cause anaplasmosis.


The symptoms are usually mild. You may not feel anything at all, or you may have flu-like symptoms including fever and fatigue within a week or two of the tick bite.


Named for the white dot on their back, the female Lone Star tick can carry the bacteria that causes both ehrlichiosis (say “air-lick-e-o-sus”) and Ehrlichiosis ewingii infection. The only difference between these two is the strain of ehrlichia bacteria that’s involved.


  • Fever, chills.
  • Severe headache.
  • Muscle aches.
  • Nausea, vomiting, diarrhea, loss of appetite.
  • Confusion.
  • Rash (more common in children)


Diagnostic serologic tests are available for ehrlichiosis and anaplasmosis, but PCR of blood is more sensitive and specific and can result in an early diagnosis because serologic tests require comparison of serial titers. Cytoplasmic inclusions in monocytes (ehrlichiosis) or in neutrophils (anaplasmosis) may be detected, but cytoplasmic inclusions are more commonly seen in anaplasmosis.

Blood and liver tests may detect hematologic and hepatic abnormalities, such as leukopenia, thrombocytopenia, and elevated aminotransferase levels.

Note 1: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, bone marrow, spleen, central nervous system, and skin conditions.

Note 2: This diagnostic code includes, but is not limited to, scrub typhus, Rickettsial pox, African tick-borne fever, Rocky Mountain spotted fever, ehrlichiosis, or anaplasmosis.


Melioidosis is a disease you get from the bacterium Burkholderia pseudomallei (B. pseudomallei). You get it from direct contact with contaminated soil or water. Its symptoms vary depending on how you got infected and whether you have underlying conditions.

Both humans and animals can get melioidosis, but people can’t get it from animals. Melioidosis is also sometimes called Whitmore’s disease.


A person can get melioidosis when they come into contact with water or soil that carries the bacterium Burkholderia pseudomallei.

This can happen if a person:

  • comes into contact with contaminated soil, especially via skin cuts or abrasions
  • drinks contaminated water
  • inhales dust or water droplets
  • Human-to-human transmission is. However, it is possible for a person to transmit the bacterium to another person.

Symptoms of melioidosis

The symptoms of melioidosis vary depending on the type of infection. Types of melioidosis include pulmonary (lung), bloodstream, local, and disseminated infections. In general, it takes two to four weeks for symptoms to appear after exposure to the bacterium. However, symptoms may take hours or years to appear, and some people have the disease without having symptoms.

Pulmonary infection

The most common way melioidosis shows up in people is through a lung infection. A lung problem can arise independently, or it can result from a blood infection. Lung symptoms can be mild, like bronchitis, or severe, including pneumonia and leading to septic shock. Septic shock is a serious blood infection that can rapidly lead to death.

Symptoms of pulmonary infection may include:

cough with normal sputum (the mixture of saliva and mucus that can rise into the throat from coughing) or no sputum, called a nonproductive cough

  • chest pain during breathing
  • high fever
  • headache and general muscle soreness
  • weight loss

Pulmonary melioidosis infection can mimic tuberculosis because they both can lead to pneumonia, high fever, night sweats, weight loss, bloody sputum, and pus or blood in the lung tissues. 

Bloodstream infection

Without fast, appropriate treatment, a pulmonary infection can progress to septicemia, which is an infection of the bloodstream. Septicemia is also known as septic shock and is the most serious form of melioidosis. It’s common and life-threatening.

Septic shock usually occurs quickly, though it may develop more gradually in some. Its symptoms include:

  • fever, especially with shivers and sweating (rigors)
  • headache
  • sore throat
  • breathing problems, including shortness of breath
  • upper abdominal pain
  • diarrhea
  • joint pain and muscle tenderness
  • disorientation
  • sores with pus on the skin or internally in the liver, spleen, muscle, or prostate

People with these specific conditions have a higher risk of developing a melioidosis bloodstream infection:

  • diabetes
  • kidney disease
  • alcohol abuse
  • liver disease
  • thalassemia
  • chronic lung infections, including cystic fibrosis, chronic obstructive pulmonary disease (COPD), and bronchiectasis
  • cancer or another condition that affects immune system function but isn’t related to HIV

People older than age 40 may also have a higher risk of contracting a melioidosis blood infection and developing more serious symptoms than younger people.

Local infection

This type of melioidosis affects the skin and organs just under the skin. Local infections can spread to the bloodstream, and bloodstream infections can cause local infections. Symptoms may include:

  • pain or swelling in a contained (localized) area, such as the parotid glands, which are most commonly associated with mumps and are located below and in front of the ear
  • fever
  • ulcerations or abscesses on, or just below, the skin, these may start as firm, gray or white nodules that become soft and inflamed, and then look like wounds caused by flesh-eating bacteria

Disseminated infection

In this type of melioidosis, sores form in more than one organ and may or may not be related to septic shock. Symptoms may include:

  • fever
  • weight loss
  • stomach or chest pain
  • muscle or joint pain
  • headache
  • seizures

Infected sores are most commonly located in the liver, lung, spleen, and prostate. Less commonly, infections occur in the joints, bones, lymph nodes, or brain.


Your doctor can diagnose a melioidosis infection by separating Burkholderia pseudomallei bacteria from:

  • Blood test
  • Urine sample
  • Throat swab
  • Skin lesion test
  • Abscesses

Doctors may also diagnose it by looking for an antibody response to the bacteria. They may identify the diagnosis as:

  • Localized infection, it’s limited to one part of the body. 
  • Lung infection
  • Bloodstream infection
  • Disseminated infection, the bacteria may have spread to different organs in the body.

Note 1: Confirm by culture or other specific diagnostic laboratory tests the initial diagnosis and any relapse or chronic activity of infection.

Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, lung lesions, or meningitis

Lyme Disease: 

Lyme disease is a bacterial infection. You get it when the blacklegged tick, also known as a deer tick, bites you and stays attached for 36 to 48 hours. If you remove the tick within 48 hours, you probably won’t get infected.

When you do get infected, the bacteria travel through your bloodstream and affect various tissues in your body. If you don’t treat Lyme disease early on, it can turn into an inflammatory condition that affects multiple systems, starting with your skin, joints, and nervous system and moving to organs later on. 

The chances you might get Lyme disease from a tick bite depend on the kind of tick, where you were when it bit you, and how long the tick was attached to you.


Lyme disease is caused by the bacterium Borrelia burgdorferi (and rarely, Borrelia mayonii). B. burgdorferi is  to people through the bite of an infected black-legged tick, also known as a deer tick.

According to the Centers for Disease Control and Prevention (CDC), infected black-legged ticks transmit Lyme disease in the Northeastern, Mid-Atlantic, and North Central United States. Western black-legged ticks transmit the disease on the Pacific Coast of the United States.


A tick bite may look like a tiny, itchy bump on your skin, much like a mosquito bite. This doesn't mean you have a tick-borne disease. Many people will not notice they've had a tick bite.

The symptoms of Lyme disease vary. They usually show up in stages. But the stages can overlap. And some people don't have symptoms of the typical early stage.

Stage 1

Early symptoms of Lyme disease usually happen within 3 to 30 days after a tick bite. This stage of disease has a limited set of symptoms. This is called early localized disease.

A rash is a common sign of Lyme disease. But it doesn't always happen. The rash is usually a single circle that slowly spreads from the site of the tick bite. It may become clear in the center and look like a target or bull's-eye. The rash often feels warm to the touch, But it's usually not painful or itchy.

Other stage 1 symptoms include:

  • Fever.
  • Headache.
  • Extreme tiredness.
  • Joint stiffness.
  • Muscle aches and pains.
  • Swollen lymph nodes.

Stage 2

Without treatment, Lyme disease can get worse.  The symptoms often show up within 3 to 10 weeks after a tick bite. Stage 2 is often more serious and widespread. It is called early disseminated disease.

Stage 2 may include the stage 1 symptoms and the following:

  • Many rashes on other parts of the body.
  • Neck pain or stiffness.
  • Muscle weakness on one or both sides of the face.
  • Immune-system activity in heart tissue that causes irregular heartbeats.
  • Pain that starts from the back and hips and spreads to the legs.
  • Pain, numbness or weakness in the hands or feet.
  • Painful swelling in tissues of the eye or eyelid.
  • Immune-system activity in eye nerves that causes pain or vision loss.

Stage 3

In the third stage, you may have symptoms from the earlier stages and other symptoms. This stage is called late disseminated disease.

In the United States, the most common condition of this stage is arthritis in large joints, particularly the knees. Pain, swelling or stiffness may last for a long time. Or the symptoms may come and go. Stage 3 symptoms usually begin 2 to 12 months after a tick bite.

The type of Lyme disease common in Europe can cause a skin condition called acrodermatitis chronic atrophicans. The skin on the backs of the hands and tops of the feet get discolored and swell. It also may show up over the elbows and knees. More-serious cases may cause damage to tissues or joints. This skin condition may show up many months to many years after a tick bite.


Diagnosing Lyme disease begins with a review of your health history, which includes looking for reports of tick bites or residence in an endemic area. A doctor or other healthcare professional will also perform a physical exam to look for the presence of a rash or other symptoms characteristic of Lyme disease. Testing during early localized infection is not recommended. Blood tests are most reliable a few weeks after the initial infection, when antibodies are present. A health care professional may order the following tests:

  • Enzyme-linked immunosorbent assay (ELISA) is used to detect antibodies against B.burgdorferi.
  • Western blot is used to confirm a positive ELISA test. It checks for the presence of antibodies to specific B. burgdorferi proteins.
  • Polymerase chain reaction (PCR) is used to evaluate people with persistent Lyme arthritis or nervous system symptoms. It’s performed on joint fluid or cerebrospinal fluid (CSF). PCR testing on CSF for diagnosis of Lyme disease is not routinely recommended due to low sensitivity. A negative test doesn’t rule out the diagnosis. In contrast, most people will have positive PCR results in joint fluid if tested before antibiotic therapy.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, Bell's palsy, radiculopathy, ocular, or cognitive dysfunction.

Parasitic diseases otherwise not specified: 

Parasitic diseases are caused by organisms known as parasites, which live on or inside a host organism and derive nourishment from it. These diseases can be caused by various types of parasites, including protozoa, helminths (worms), and ectoparasites. Parasitic infections can range from relatively harmless to severe and life-threatening, and they can affect individuals worldwide.

Causes of Parasitic Diseases

The causes of parasitic diseases can vary depending on the specific parasite involved. Some common causes include:

  • Ingestion of contaminated food or water

Parasites can be transmitted through the consumption of contaminated food or water, particularly in areas with poor sanitation practices.

  • Contact with infected animals

Certain parasites can be transmitted to humans through direct contact with infected animals or their feces.

  • Insect or arthropod bites

Some parasites are transmitted to humans through the bites of infected insects or arthropods, such as mosquitoes or ticks.

  • Soil or environmental exposure

Certain parasites can be acquired through contact with contaminated soil or environmental surfaces.

Symptoms of Parasitic Diseases

The symptoms of parasitic diseases can vary depending on the type of parasite and the specific infection. Some common symptoms include:

  • Gastrointestinal symptoms

These can include diarrhea, abdominal pain, nausea, vomiting, and loss of appetite.

  • Fatigue and weakness

Parasitic infections can cause fatigue, weakness, and general malaise.

  • Skin manifestations 

Some parasitic infections can lead to skin rashes, itching, or sores.

  • Fever

In some cases, parasitic infections can cause fever.

  • Respiratory symptoms

Certain parasitic infections can affect the respiratory system and cause symptoms such as coughing or difficulty breathing.

  • Neurological symptoms

In rare cases, parasitic infections can affect the nervous system and lead to neurological symptoms such as seizures or confusion.

Diagnosis of Parasitic Diseases

Diagnosing parasitic diseases involves a combination of medical history, physical examination, and laboratory tests. Some common diagnostic methods include:

  • Ova and Parasite Test 
  • Xylose Testing

Note: Rate under the appropriate body system any residual disability of infection.

Hyperinfection syndrome or disseminated strongyloidiasis: 

Hyperinfection syndrome and disseminated strongyloidiasis are most frequently associated with subclinical infection in patients receiving high-dose corticosteroids for the treatment of asthma or chronic obstructive pulmonary disease (COPD) exacerbations. Subsequent impaired host immunity leads to accelerated autoinfection and an overwhelming number of migrating larvae. In chronic strongyloidiasis and in hyperinfection syndrome the larvae are limited to the GI tract and the lungs whereas in disseminated strongyloidiasis the larvae invade numerous organs. Left untreated, the mortality rates of hyperinfection syndrome and disseminated strongyloidiasis can approach 90%.


Strongyloidiasis is caused by the parasitic roundworm S. stercoralis. This worm infects mainly humans. Most humans get the infection by coming into contact with contaminated soil.

It’s most often found in tropical and subtropical climates, but it can occasionally be found in more temperate climates. This may include parts of the southern United States and Appalachia.

Once a person comes into contact with S. stercoralis, the infection follows the lifecycle of the worm. The worm’s lifecycle includes the following stages:

  • The tiny worms penetrate your skin and enter your bloodstream.
  • The worms then move through your bloodstream and pass through the right side of your heart and into the lungs.
  • The parasites travel from the lungs up the windpipe and into your mouth.
  • You unknowingly swallow the worms, and they travel into your stomach.
  • The worms move into your small intestine.
  • The worms lay eggs that hatch and become larvae.
  • The larvae are expelled from your body in your feces.
  • The larvae can infect your body by penetrating the skin around your anus, or they can develop into mature worms and infect someone else.
  • The worms can also live and reproduce in soil, without a host.
  • Rarely, the worms can penetrate the intestine of the host as larvae rather than pass out of the body through the feces.


The following are signs and symptoms that can be seen with hyperinfection syndrome and disseminated strongyloidiasis:

Gastrointestinal manifestations

  • Abdominal pain, nausea, vomiting, diarrhea
  • Ileus, bowel edema, intestinal obstruction
  • Mucosal ulceration, massive hemorrhage, and subsequent peritonitis or bacterial sepsis
  • Pulmonary manifestations and findings
  • Cough, wheezing, dyspnea, hoarseness
  • Pneumonitis
  • Hemoptysis
  • Respiratory failure
  • Diffuse interstitial infiltrates or consolidation on chest radiographs

Neurologic findings

  • Aseptic or gram-negative meningitis
  • Larvae have been reported in the CSF, meningeal vessels, dura, epidural, subdural, and subarachnoid spaces

Systemic signs and symptoms

  • Peripheral edema and ascites secondary to hypoalbuminemia from protein losing enteropathy
  • Recurrent gram negative bacteremia or sepsis from larvae carrying bacteria that penetrate mucosal walls
  • Syndrome of inappropriate secretion of anti-diuretic hormone (SIADH)
  • Peripheral eosinophilia is frequently absent

Cutaneous manifestations

  • Recurrent maculopapular or urticarial rash that can be found anywhere on the skin but is most commonly found along the buttocks, perineum, and thighs due to repeated auto-infection
  • Larva currens serpiginous or urticarial rash that advances as rapidly as 10cm/hr. 


Strongyloidiasis can be difficult to diagnose because examining the stool under a microscope doesn't always show the infection. Examining the stool on five occasions at different times can be more reliable. Strongyloidiasis can sometimes be diagnosed with a blood test. More advanced cases may be diagnosed by testing fluid from your lungs or small intestine.


Schistosomiasis is an infection caused by trematodes (flukes). These schistosomes (also called blood flukes) are parasitic flatworms that belong to the genus Schistosoma. Parasites are creatures who live in or on another organism (host) and get their food from the host. This has a negative effect on the host.

In the case of schistosomiasis, the flukes are found in snails and then are shed into the water. If your skin comes in contact with contaminated water, the parasites can move into you and live there for years. The form of the parasite that infects humans after developing in the snail has a kind of forked head that allows it to penetrate your skin.

The three main types of schistosomes are responsible for the two main forms of the condition: urogenital schistosomiasis and intestinal schistosomiasis. This condition is also known as bilharzia or snail fever.


The worms that cause schistosomiasis live in freshwater, such as:

  • ponds
  • lakes
  • rivers
  • reservoirs
  • canals

Showers that take unfiltered water directly from lakes or rivers may also spread the infection, but the worms aren't found in the sea, chlorinated swimming pools or properly treated water supplies. You can become infected if you come into contact with contaminated water for example, when paddling, swimming or washing – and the tiny worms burrow into your skin.

Once in your body, the worms move through your blood to areas such as the liver and bowel. After a few weeks, the worms start to lay eggs. Some eggs remain inside the body and are attacked by the immune system, while some are passed out in the person's pee or poo.

Without treatment, the worms can keep laying eggs for several years. If the eggs pass out of the body into water, they release tiny larvae that need to grow inside freshwater snails for a few weeks before they're able to infect another person.  This means it's not possible to catch the infection from someone else who has it.


Many people have no symptoms of schistosomiasis. Early signs and symptoms (those that happen within days of being infected) may include itchiness and a skin rash.

Later symptoms (those that develop within 30 to 60 days of being infected) may include:

  • Fever.
  • Chills.
  • Cough.
  • Muscle aches and pain.

If you aren’t treated, symptoms that develop after years of being infected may include:

  • Pain in your stomach.
  • Enlarged liver (hepatomegaly).
  • Blood in your urine (pee), also called hematuria.
  • Difficulty or pain while urinating (dysuria).
  • Blood in feces (poop), also called hematochezia.
  • Miscarriage.

Chronic (long-lasting) schistosomiasis may make it more likely that you’ll develop scars on your liver or bladder cancer.

In rare cases, you might have eggs in your brain or spinal cord. If this is true, you may have seizures, become paralyzed or have an inflamed spinal cord.


Schistosomiasis is diagnosed through the detection of parasite eggs in stool or urine specimens. Antibodies and/or antigens detected in blood or urine samples are also indications of infection.

For urogenital schistosomiasis, a filtration technique using nylon, paper or polycarbonate filters is the standard diagnostic technique. Children with S. haematobium almost always have microscopic blood in their urine which can be detected by chemical reagent strips.

The eggs of intestinal schistosomiasis can be detected in faecal specimens through a technique using methylene blue-stained cellophane soaked in glycerin or glass slides, known as the Kato-Katz technique. In S. mansoni transmission areas, CCA (Circulating Cathodic Antigen) test can also be used.

For people living in non-endemic or low-transmission areas, serological and immunological tests may be useful in showing exposure to infection and the need for thorough examination, treatment and follow-up.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, conditions of the liver, intestinal system, female genital tract, genitourinary tract, or central nervous system.

Hemorrhagic fevers, including dengue, yellow fever, and others: 

Viral hemorrhagic fevers (VHFs) are a group of diseases that are caused by several distinct families of viruses. The term “viral hemorrhagic fever” refers to a condition that affects many organ systems of the body, damages the overall cardiovascular system, and reduces the body’s ability to function on its own. Symptoms of this type of condition can vary but often include bleeding, or hemorrhaging.

Some viral hemorrhagic fevers include:

  • Dengue
  • Ebola
  • Lassa
  • Marburg
  • Yellow fever

These diseases most commonly occur in tropical areas. In the United States, people who get them usually have recently traveled to one of those areas.


These illnesses are caused by viruses from 4 groups:

  • Arenaviruses
  • Filoviruses
  • Bunyaviruses
  • Flaviviruses

These viruses infect insects or rodents. You can become infected from exposure to the body, body fluids, or the droppings of an infected rodent or through an insect bite, usually from a mosquito or tick. Some of the viruses  also spread from person to person. Viruses can also be spread if you crush an infected tick.


Symptoms of VHFs vary depending on the disease. Early in the illness, they often include:

  • Body aches
  • Dizziness
  • Fatigue (extreme tiredness)
  • Fever
  • Headache
  • Rashes

In severe cases, VHFs can cause symptoms that include:

  • Bleeding from the eyes, ears or mouth
  • Difficulty breathing
  • Coma (a prolonged and deep unconscious state)
  • Internal bleeding
  • Organ failure
  • Shock (a condition where the organs do not receive enough blood or oxygen)
  • Death 


Diagnosing specific viral hemorrhagic fevers in the first few days of illness can be difficult because the early signs and symptoms,  high fever, muscle aches, headaches and extreme fatigue are common to many other diseases.

To help with diagnosis, tell your doctor about your medical and travel history and your exposure to rodents or mosquitoes. Include the countries you visited and the dates, as well as any contact you might have had with possible infection sources.

Lab tests, usually using a blood sample, are needed to confirm a diagnosis. Because viral hemorrhagic fevers are particularly infectious and contagious, these tests are usually performed in specially designated labs using strict precautions.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, conditions of the central nervous system, liver, or kidney.

Campylobacter jejuni infection: 

Campylobacter is a genus of bacteria that is among the most common causes of bacterial diarrheal illness in humans worldwide. The name means “curved rod,” derived from the Greek campylos (curved) and baktron (rod). While there are dozens of species, three represent the main sources of human infection: Campylobacter jejuni, Campylobacter coli, and Campylobacter lari. C. jejuni is the most commonly implicated species.

Campylobacteriosis as a disease entity was first recognized by Theodor Escherich in 1886, who described the symptoms of intestinal Campylobacter infections in children as “cholera infantum” or “summer complaint.” However, the organisms were not easily cultured or characterized, which precluded their recognition as major causes of disease until the 1970s.

Campylobacter jejuni is a gram-negative rod-shaped bacterium that grows best in a high temperature (42°C, or 107°F) and low oxygen environment. These characteristics represent adaptations to growth in its normal habitat, the intestines of warm-blooded birds and mammals. Several closely-related bacterial species with similar characteristics, C. coli, C. fetus, and C. upsalienis, may also cause disease in humans but are responsible for less than 1% of human infections annually. The optimal conditions required for the growth of Campylobacter make it difficult to isolate in the laboratory from fecal specimens without special techniques, including the use of selective culture media.


People can get Campylobacter infection by eating raw or undercooked poultry or eating something that touched it. They can also get it from eating other foods, including seafood, meat, and produce, by contact with animals, and by drinking untreated water.


A Campylobacter infection has symptoms that you would expect with so-called stomach flu (which is not the same as influenza, a respiratory illness). You may have:

  • Diarrhea (sometimes with blood).
  • Fever.
  • Headache.
  • Nausea and vomiting.
  • Stomach cramps.

Not everyone will get sick. Those who do get sick usually start feeling ill one to seven days after infection. Symptoms last about one week.


Your health care provider will perform a physical exam. These tests may be done:

  • Complete blood count (CBC) with differential
  • Stool sample testing for white blood cells
  • Stool culture for Campylobacter jejuni

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, Guillain-Barre syndrome, reactive arthritis, or uveitis.

Coxiella burnetii infection (Q fever) 

Q fever, also called query fever, is a bacterial infection caused by the bacteria Coxiella burnetii. The bacteria are most commonly found in cattle, sheep, and goats around the world. Humans typically get Q fever when they breathe in dust that was contaminated by infected animals.

Farmers, veterinarians, and people who work with these animals in labs are at the highest risk of being infected. The highest amounts of bacteria are found in the “birth products” (placenta, amniotic fluid, etc.) of infected animals.

The disease may cause mild symptoms similar to the flu. Many people have no symptoms at all. Mild forms of the disease may clear up in a few weeks without any treatment.

In rare cases, a more serious form of disease develops if the infection is chronic, which means it persists for 6 months (and there are some case reports indicating that it may persist for more than 6 months).

A more serious form also can develop if the infection is recurrent, which means it comes back. People with heart valve problems or weak immune systems are at the highest risk of developing these types of Q fever.

Chronic Q fever is very serious because it can damage a person’s vital organs, including the:

  • heart
  • liver
  • brain
  • lungs

More severe or chronic forms of Q fever can be treated with antibiotics. Those at risk for Q fever can prevent the disease by disinfecting contaminated areas and washing their hands thoroughly.


Q fever is a disease caused by the bacteria Coxiella burnetii. This bacteria naturally infects some animals, such as goats, sheep, and cattle. C. burnetii bacteria are found in the birth products (i.e. placenta, amniotic fluid), urine, feces, and milk of infected animals.


Initial (acute) symptoms of Q fever are flu-like and start three to 30 days after exposure. Some people continue to have symptoms for over a year after their initial exposure, called Q fever fatigue syndrome (QFS). Others develop symptoms of a more serious infection called chronic Q fever.

Symptoms of acute Q fever

Symptoms of acute Q fever are usually flu-like but can vary a lot. It might cause pneumonia, inflammation of your brain or its covering (encephalitis or meningitis) or inflammation in your liver (hepatitis). Symptoms you might experience include:

  • Fever.
  • Extreme fatigue.
  • Chills.
  • Sweats.
  • Muscle aches.
  • Sensitivity to light (photophobia).
  • Severe headaches.
  • Nausea and vomiting.
  • Diarrhea.
  • Cough.
  • Chest pain.
  • Stomach pain.
  • Rash-like spots under your skin (purpura).
  • Shortness of breath (dyspnea).

Symptoms of Q fever fatigue syndrome (QFS)

About 20% of people with Q fever will have fatigue and other symptoms that continue for months or years after initial exposure. Symptoms of Q fever fatigue syndrome include:

  • Extreme fatigue.
  • Headaches.
  • Sweats.
  • Joint pain.
  • Muscle aches.

Symptoms of chronic Q fever (persistent Q fever)

Chronic Q fever starts months to years after your initial C. burnetii infection, even if you didn’t have symptoms at the time. While it most commonly affects your heart, heart valves and blood vessels, the symptoms can vary depending on what parts of your body are affected.

Symptoms of chronic Q fever include:

  • Low-grade fever.
  • Night sweats.
  • Weight loss.
  • Fatigue.
  • Shortness of breath.
  • Swelling of your legs or feet.


The symptoms of Q fever are similar to many other diseases, often making diagnosis difficult. See your healthcare provider if you develop symptoms after spending time with or near animals particularly sheep, goats, and cattle—or in areas where these animals may have been.

Your healthcare provider may order blood tests to look for Q fever or for other diseases.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, chronic hepatitis, endocarditis, osteomyelitis, post Q-fever chronic fatigue syndrome, or vascular infections.

Nontyphoid salmonella infections: 

Nontyphoidal Salmonella infections are common and remain a significant public health problem in the US. Many serotypes of Salmonella have been given names and are referred to informally as if they were separate species even though they are not. Most nontyphoidal Salmonella infections are caused by S. enterica subspecies enterica serotype Enteritidis, S. Typhimurium, S. Newport, S. Heidelberg, and S. Javiana.

Human disease occurs by direct and indirect contact with numerous species of infected animals, the foodstuffs derived from them, and their excreta. Contaminated meat, poultry, raw milk, eggs, egg products, and water are common sources of Salmonella. Other reported sources include infected pet turtles and reptiles, carmine red dye, and contaminated marijuana.

Cause and transmission 

  • Salmonellosis is a disease caused by the bacteria Salmonella.
  • Salmonella bacteria are widely distributed in domestic and wild animals. They are prevalent in food animals such as poultry, pigs, and cattle; and in pets, including cats, dogs, birds, and reptiles such as turtles.
  • Salmonella can pass through the entire food chain from animal feed, primary production, and all the way to households or food-service establishments and institutions.
  • Salmonellosis in humans is generally contracted through the consumption of contaminated food of animal origin (mainly eggs, meat, poultry, and milk), although other foods, including green vegetables contaminated by manure, have been implicated in its transmission.
  • Person-to-person transmission can also occur through the faecal-oral route.
  • Human cases also occur where individuals have contact with infected animals, including pets. These infected animals often do not show signs of disease.


Salmonella infection may manifest as:

  • Gastroenteritis
  • Enteric fever
  • Bacteremia
  • Focal disease

Gastroenteritis usually starts 12 to 48 hours after ingestion of organisms, with nausea and cramping abdominal pain followed by diarrhea, fever, and sometimes vomiting. Usually, the stool is watery but may be a pastelike semisolid. Rarely, mucus or blood is present. The disease is usually mild, lasting 1 to 4 days. Occasionally, a more severe, protracted illness occurs. About 10 to 30% of adults develop reactive arthritis weeks to months after diarrhea stops. This disorder causes pain and swelling, usually in the hips, knees, and Achilles tendon.

Enteric fever is a term often used interchangeably with typhoid fever. Enteric fever typically refers to a form of typhoid caused by nontyphoidal Salmonella infections caused by S. enterica subspecies; it is characterized by fever, prostration, and septicemia.

Bacteremia is relatively uncommon in patients with gastroenteritis, except in infants and older people. However, S. Choleraesuis, S. Typhimurium, and S. Heidelberg, among others, can cause a sustained and frequently lethal bacteremic syndrome lasting ≥ 1 week, with prolonged fever, headache, malaise, and chills but rarely diarrhea. Sustained bacteremia suggests endovascular infection, such endocarditis or infection of an abdominal aortic aneurysm, which can occur as a complication of Salmonella bacteremia. Patients may have recurrent episodes of bacteremia or other invasive infections (eg, infectious arthritis) due to Salmonella. Bacteremia is more likely to occur in immunologically compromised patients (eg, those with HIV/AIDS) and in patients with a hemolytic condition (eg, sickle cell anemia, malaria, Oroya fever), who are also more likely to develop a focal infection, such as infectious arthritis, osteomyelitis, pneumonia, endarteritis (eg, infected aortic aneurysm), endocarditis, urinary tract infection, cholangitis, and meningitis. Recurrent or multiple episodes of Salmonella infection in a patient without other risk factors should prompt HIV testing.

Focal Salmonella infection can occur with or without sustained bacteremia, causing pain in or referred from the involved organ—the gastrointestinal tract (liver, gallbladder, appendix), endothelial surfaces (eg, atherosclerotic plaques, ileofemoral or aortic aneurysms, heart valves), pericardium, meninges, lungs, joints, bones, genitourinary tract, or soft tissues. Preexisting solid tumors are occasionally seeded and develop abscesses that may, in turn, become a source of Salmonella bacteremia. S. Choleraesuis and S. Typhimurium are the most common causes of focal infection.


Culturing organisms continues to be the mainstay of clinical diagnostic testing for nontyphoidal Salmonella infection. Approximately 90% of isolates are obtained from routine stool culture, but isolates can also be obtained from other sites of infection if present, including blood, urine, abscesses, and cerebrospinal fluid. Although culture-independent diagnostic tests are used increasingly by clinical laboratories to diagnose Salmonella infection, isolates are necessary for serotyping and antimicrobial susceptibility testing. Serologic testing to detect infection with Salmonella is not advised.

Most states mandate that Salmonella isolates or clinical material be submitted to the local or state public health laboratory. To understand submission requirements in a particular state, clinical laboratories are advised to review the disease reporting and mandatory isolate submission regulations of that state and to contact their local public health department with any questions. Salmonellosis is a nationally notifiable disease.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, reactive arthritis.

Shigella infections: 

Shigellosis is a bacterial infection that affects the digestive system. It’s caused by a group of bacteria called Shigella. The Shigella bacteria is spread through contaminated water and food or through contact with contaminated feces. The bacteria release toxins that irritate the intestines, causing the primary symptom of diarrhea.

According to the Centers for Disease Control and Prevention (CDC), about 450,000 people in the United States report having shigellosis every year. The symptoms vary in intensity. You may have a mild shigellosis infection and not even realize or report it.


Shigella bacteria are usually found in the stool (feces, or poop) of people who are infected. The bacteria are spread when someone comes into contact with the stool of an infected person or comes into contact with an item that’s been contaminated with the stool or the bacteria.

People get shigellosis by eating food or drinking water that has been contaminated, or through sexual contact with an infected person. Many different foods can be contaminated, but Shigella is found typically in uncooked vegetables or shellfish.


Signs and symptoms of shigella infection usually begin a day or two after contact with shigella. But it may take up to a week to develop. Signs and symptoms may include:

  • Diarrhea (often containing blood or mucus)
  • Stomach pain or cramps
  • Fever
  • Nausea or vomiting

Symptoms generally last for about five to seven days. In some cases, symptoms may last longer. Some people have no symptoms after they've been infected with shigella. However, their feces may still be contagious up to a few weeks.


Since there are many causes of diarrhea, a lab test may be needed to figure out whether you have shigellosis. Your doctor may ask you to give a stool sample to see whether you have shigella bacteria.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, hemolytic-uremic syndrome or reactive arthritis.

West Nile virus infection: 

West Nile virus is an infectious disease caused by microscopic germs (called a virus) that can make you sick. Mosquitoes infected with the West Nile virus can give it to people or animals, such as horses, when they bite the skin.

In most people, West Nile virus causes minor or no symptoms. In rare instances, West Nile virus can cause a dangerous neurological infection (an infection in your nerves and brain). A neurological infection can pose a serious threat to your health.


West Nile virus is spread to humans through the bite of an infected female mosquito. The mosquitoes get the virus when they bite an infected bird. Crows and jays are the most common birds linked to the virus. But at least 110 other bird species also have the virus.

West Nile virus isn't spread between humans. However, in a few cases it has spread through organ transplant. Health officials think the organ donor acquired the virus through a blood transfusion. All blood is screened for the virus. The risk for getting West Nile virus from blood is much lower than the risk of not having any procedure that would call for a blood transfusion.


Most people infected with the West Nile virus have no signs or symptoms.

Mild infection signs and symptoms

About 20% of people develop a mild infection called West Nile fever. Common signs and symptoms include:

  • Fever
  • Headache
  • Body aches
  • Vomiting
  • Diarrhea
  • Fatigue
  • Skin rash
  • Serious infection signs and symptoms

In less than 1% of infected people, the virus causes a serious nervous system (neurological) infection. This may include inflammation of the brain (encephalitis) or of the membranes surrounding the brain and spinal cord (meningitis).

Signs and symptoms of neurological infections include:

  • High fever
  • Severe headache
  • Stiff neck
  • Disorientation or confusion
  • Coma
  • Tremors or muscle jerking
  • Seizures
  • Partial paralysis or muscle weakness
  • Vision loss
  • Numbness

Signs and symptoms of West Nile fever usually last a few days. But signs and symptoms of encephalitis or meningitis can linger for weeks or months. Certain neurological effects, such as muscle weakness, can be permanent.


Signs of West Nile virus infection are similar to those of other viral infections. There may be no specific findings on a physical examination. About one half of people with West Nile virus infection may have a rash.

Tests to diagnose West Nile virus include:

  • Blood test or a spinal tap to check for antibodies against the virus
  • Head CT scan
  • Head MRI scan

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, variable physical, functional, or cognitive disabilities.

Lupus erythematosus, systemic (disseminated)  

The immune system normally fights off dangerous infections and bacteria to keep the body healthy. An autoimmune disease occurs when the immune system attacks the body because it confuses it for something foreign. There are many autoimmune diseases, including systemic lupus erythematosus (SLE).

The term lupus has been used to identify a number of immune diseases that have similar clinical presentations and laboratory features, but SLE is the most common type of lupus. People are often referring to SLE when they say lupus.

SLE is a chronic disease that can have phases of worsening symptoms that alternate with periods of mild symptoms. Most people with SLE are able to live a normal life with treatment.

According to the Lupus Foundation of America, at least 1.5 million Americans are living with diagnosed lupus. The foundation believes that the number of people who actually have the condition is much higher and that many cases go undiagnosed.


There are several different types of lupus. Systemic lupus erythematosus is the most common. Other types of lupus include:

Cutaneous lupus erythematosus: This type of lupus affects the skin, cutaneous is a term meaning skin. Individuals with cutaneous lupus erythematosus may experience skin issues like a sensitivity to the sun and rashes. Hair loss can also be a symptom of this condition.

Drug-induced lupus: These cases of lupus are caused by certain medications. People with drug-induced lupus may have many of the same symptoms of systemic lupus erythematosus, but it’s usually temporary. Often, this type of lupus goes away once you stop the medication that’s causing it.

Neonatal lupus: A rare type of lupus, neonatal lupus is a condition found in infants at birth. Children born with neonatal lupus have antibodies that were passed to them from their mother — who either had lupus at the time of the pregnancy or may have the condition later in life. Not every baby born to a mother with lupus will have the disease.


The cause of SLE is not clearly known. It may be linked to the following factors:

  • Genetic
  • Environmental
  • Hormonal
  • Certain medicines

SLE is more common in women than men by nearly 10 to 1. It may occur at any age. However, it appears most often in young women between the ages of 15 and 44.


No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes called flares, when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

  • Fatigue
  • Fever
  • Joint pain, stiffness and swelling
  • Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
  • Skin lesions that appear or worsen with sun exposure
  • Fingers and toes that turn white or blue when exposed to cold or during stressful periods
  • Shortness of breath
  • Chest pain
  • Dry eyes
  • Headaches, confusion and memory loss


To be diagnosed with lupus, you must have 4 out of 11 common signs of the disease. Nearly all people with lupus have a positive test for antinuclear antibody (ANA). However, having a positive ANA alone does not mean you have lupus.

The health care provider will do a complete physical exam. You may have a rash, arthritis, or edema in the ankles. There may be an abnormal sound called a heart friction rub or pleural friction rub. Your provider will also do a nervous system exam.

Tests used to diagnose SLE may include:

  • Antinuclear antibody (ANA)
  • Complete blood count (CBC) with differential
  • Chest x-ray
  • Serum creatinine
  • Urinalysis

You may also have other tests to learn more about your condition. Some of these are:

  • Antinuclear antibody (ANA) panel
  • Complement components (C3 and C4)
  • Antibodies to double-stranded DNA
  • Coombs test - direct
  • Cryoglobulins
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
  • Kidney function blood tests
  • Liver function blood tests
  • Rheumatoid factor
  • Antiphospholipid antibodies and lupus anticoagulant test
  • Kidney biopsy
  • Imaging tests of the heart, brain, lungs, joints, muscles or intestines

Note: Evaluate this condition either by combining the evaluations for residuals under the appropriate system, or by evaluating DC 6350, whichever method results in a higher evaluation.

HIV-Related Illness:

What is HIV?

HIV stands for human immunodeficiency virus. HIV infects and destroys cells of your immune system, making it hard to fight off other diseases. When HIV has severely weakened your immune system, it can lead to acquired immunodeficiency syndrome (AIDS).

Because HIV works backward to insert its instructions into your DNA, it is called a retrovirus.

What is AIDS?

AIDS is the final and most serious stage of an HIV infection. People with AIDS have very low counts of certain white blood cells and severely damaged immune systems. They may have additional illnesses that indicate that they have progressed to AIDS. Without treatment, HIV infections progress to AIDS in about 10 years.

HIV related illnesses 

Infections common to HIV/AIDS

Pneumocystis pneumonia (PCP): This fungal infection can cause severe illness. Although it's declined significantly with current treatments for HIV/AIDS, in the U.S., PCP is still the most common cause of pneumonia in people infected with HIV.

Candidiasis (thrush): Candidiasis is a common HIV-related infection. It causes inflammation and a thick, white coating on your mouth, tongue, esophagus or vagina.

Tuberculosis (TB): TB is a common opportunistic infection associated with HIV. Worldwide, TB is a leading cause of death among people with AIDS. It's less common in the U.S. thanks to the wide use of HIV medications.

Cytomegalovirus: This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other organs.

Cryptococcal meningitis: Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus found in soil.

Toxoplasmosis: This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, which may then spread to other animals and humans. Toxoplasmosis can cause heart disease, and seizures occur when it spreads to the brain.

Cancers common to HIV/AIDS

Lymphoma: This cancer starts in the white blood cells. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.

Kaposi's sarcoma: A tumor of the blood vessel walls, Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs.

HPV-related cancers: These are cancers caused by human papillomavirus (HPV) infection. They include anal, oral and cervical cancer.

Other complications

Wasting syndrome: Untreated HIV/AIDS can cause significant weight loss, often accompanied by diarrhea, chronic weakness and fever.

Neurological complications: HIV can cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. HIV-associated neurocognitive disorders (HAND) can range from mild symptoms of behavioral changes and reduced mental functioning to severe dementia causing weakness and inability to function.

Kidney disease: HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. It most often affects Black or Hispanic people.

Liver disease: Liver disease is also a major complication, especially in people who also have hepatitis B or hepatitis C.


The virus is spread (transmitted) person-to-person through certain body fluids:

  • Blood
  • Semen and pre seminal fluid
  • Rectal fluids
  • Vaginal fluids
  • Breast milk

HIV can be spread if these fluids come in contact with:

  • Mucous membranes (inside of the mouth, penis, vagina, rectum)
  • Damaged tissue (tissue that has been cut or scraped)
  • Injection into the blood stream
  • HIV cannot be spread through sweat, saliva, or urine.

In the United States, HIV is mainly spread:

  • Through vaginal or anal sex with someone who has HIV without using a condom or is not taking medicines to prevent or treat HIV
  • Through needle sharing or other equipment used to inject drugs with someone who has HIV

Less often, HIV is spread:

From mother to child: A pregnant woman can spread the virus to her fetus through their shared blood circulation, or a nursing mother can pass it to her baby through her breast milk. 

Through needle sticks or other sharp objects that are contaminated with HIV (mainly health care workers).

The virus is NOT spread by:

  • Casual contact, such as hugging or closed-mouth kissing
  • Mosquitoes or pets
  • Participating in sports
  • Touching items that were touched by a person infected with the virus
  • Eating food handled by a person with HIV

HIV and blood or organ donation:

HIV is not spread to a person who donates blood or organs. People who donate organs are never in direct contact with the people who receive them. Likewise, a person who donates blood is never in contact with the person receiving it. In all of these procedures, sterile needles and instruments are used.

While very rare, in the past HIV has been spread to a person receiving blood or organs from an infected donor. However, this risk is very small because blood banks and organ donor programs thoroughly check (screen) donors, blood, and tissues.

Risk factors for getting HIV include:

  • Having unprotected anal or vaginal sex. Receptive anal sex is the riskiest. Having multiple partners also increases the risk. Using a new condom correctly every time you have sex greatly helps lower this risk.
  • Using drugs and sharing needles or syringes.
  • Having a sexual partner with HIV who is not taking HIV medicines.
  • Having a sexually-transmitted disease (STD).


The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection (Acute HIV)

Some people infected by HIV develop a flu-like illness within 2 to 4 weeks after the virus enters the body. This illness, known as primary (acute) HIV infection, may last for a few weeks.

Possible signs and symptoms include:

  • Fever
  • Headache
  • Muscle aches and joint pain
  • Rash
  • Sore throat and painful mouth sores
  • Swollen lymph glands, mainly on the neck
  • Diarrhea
  • Weight loss
  • Cough
  • Night sweats

These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.

Clinical latent infection (Chronic HIV)

In this stage of infection, HIV is still present in the body and in white blood cells. However, many people may not have any symptoms or infections during this time.

This stage can last for many years if you're receiving antiretroviral therapy (ART). Some people develop more severe diseases much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy your immune cells, the cells in your body that help fight off germs,  you may develop mild infections or chronic signs and symptoms such as:

  • Fever
  • Fatigue
  • Swollen lymph nodes  often one of the first signs of HIV infection
  • Diarrhea
  • Weight loss
  • Oral yeast infection (thrush)
  • Shingles (herpes zoster)
  • Pneumonia

Progression to AIDS

Access to better antiviral treatments has dramatically decreased deaths from AIDS worldwide, even in resource-poor countries. Thanks to these life-saving treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 8 to 10 years.

When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop diseases that wouldn't usually cause illness in a person with a healthy immune system. These are called opportunistic infections or opportunistic cancers.

The signs and symptoms of some of these infections may include:

  • Sweats
  • Chills
  • Recurring fever
  • Chronic diarrhea
  • Swollen lymph glands
  • Persistent white spots or unusual lesions on your tongue or in your mouth
  • Persistent, unexplained fatigue
  • Weakness
  • Weight loss
  • Skin rashes or bumps


Several different tests can be used to diagnose HIV. Healthcare providers determine which test is best for each person.

  • Antibody/antigen tests
  • Antibody tests

Other antibody tests can be done at home:

  • OraQuick HIV Test
  • Home Access HIV-1 Test System
  • Nucleic acid test (NAT)

Note 1: In addition to standard therapies and regimens, the term “approved medication(s)” includes treatment regimens and medications prescribed as part of a research protocol at an accredited medical institution.

Note 2: Diagnosed psychiatric illness, central nervous system manifestations, opportunistic infections, and neoplasms may be rated separately under the appropriate diagnostic codes if a higher overall evaluation results, provided the disability symptoms do not overlap with evaluations otherwise assignable above.

Note 3: The following list of opportunistic infections are considered AIDS-defining conditions, that is, a diagnosis of AIDS follows if a person has HIV and one more of these infections, regardless of the CD4 count--candidiasis of the bronchi, trachea, esophagus, or lungs; invasive cervical cancer; coccidioidomycosis; cryptococcosis; cryptosporidiosis; cytomegalovirus (particularly CMV retinitis); HIV-related encephalopathy; herpes simplex-chronic ulcers for greater than one month, or bronchitis, pneumonia, or esophagitis; histoplasmosis; isosporiasis (chronic intestinal); Kaposi's sarcoma; lymphoma; mycobacterium avium complex; tuberculosis; pneumocystis jirovecii (carinii) pneumonia; pneumonia, recurrent; progressive multifocal leukoencephalopathy; salmonella septicemia, recurrent; toxoplasmosis of the brain; and wasting syndrome due to HIV.

Chronic fatigue syndrome (CFS) is a muddled issue described by outrageous fatigue that goes on for at any rate a half year and that can't be completely clarified by a hidden ailment. The fatigue deteriorates with physical or mental movement yet doesn't improve with rest.

Some Common Symptoms Include:

  • Rest that isn't reviving
  • Troubles with memory, center and focus
  • Dizziness that deteriorates with dropping from resting or sitting to standing

This condition is otherwise called myalgic encephalomyelitis. The latest term proposed is systematic exertional intolerance disease (SEID).

The reason for chronic fatigue syndrome is obscure, in spite of the fact that there are numerous speculations — going from viral diseases to mental pressure. A few specialists accept chronic fatigue syndrome may be set off by a blend of variables.

There's no single test to affirm an analysis of chronic fatigue syndrome. You may require an assortment of clinical trials to preclude other medical issues that have comparative symptoms. Therapy for chronic fatigue syndrome centers around improving symptoms.


Symptoms of chronic fatigue syndrome can change from individual to individual, and the seriousness of symptoms can vary from every day. Signs and symptoms may include:

  • Fatigue
  • Issues with memory or memory loss
  • Sore throat
  • Migraines
  • Developed lymph hubs in your neck or armpits
  • Unexplained muscle or joint torment
  • Dizziness that deteriorates with dropping from resting or sitting to standing
  • Unrefreshing rest
  • Outrageous fatigue after physical or mental exercise

When Should One See A Specialist?

Fatigue can be a side effect of numerous illnesses, like diseases or mental problems. As a rule, see your primary care physician if you have experienced extreme fatigue.

What Causes Chronic Fatigue Syndrome?

The reason for chronic fatigue syndrome is as yet unclear. A few people might be brought into the world with an inclination for the issue, which is then set off by a blend of components.

  • Viral contaminations
  • Immune system issues.
  • Hormonal imbalance.
  • Physical or passionate injury

Chronic Fatigue Syndrome (CFS):

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID), is a long-term illness characterized by extreme fatigue or tiredness that doesn’t go away with rest and can’t be explained by an underlying medical condition. CFS can affect anyone, though it’s most common among women and people between their mid-20s and mid-40s.

Causes of CFS

The causes of CFS aren’t fully understood yet. Some theories include viral infection, psychological stress, or a combination of factors. Because no single cause has been identified, and because many other conditions produce similar symptoms, CFS can be difficult to diagnose.

Symptoms of CFS

Symptoms of CFS vary based on the individual and the severity of the condition. Some common symptoms include:

  • Extreme fatigue or tiredness that doesn’t go away with rest
  • Difficulty sleeping or insomnia
  • Muscle pain or weakness
  • Joint pain
  • Headaches
  • Sore throat
  • Swollen lymph nodes
  • Difficulty concentrating or remembering things
  • Sensitivity to light, noise, or certain foods

Diagnosis of CFS

Because no single test can diagnose CFS, diagnosis involves ruling out other possible causes of the symptoms. Your doctor will have to rule out other causes for your fatigue when determining a diagnosis. While CFS was previously a controversial diagnosis, it’s now widely accepted as a medical condition. CFS can be diagnosed based on the following criteria:

  1. Severe and chronic tiredness lasts for more than 6 months
  2. No other underlying medical condition can explain the fatigue
  3. The fatigue is not due to ongoing exertion or other factors that could cause fatigue

Description Percentage

Which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care

Description Percentage

Which are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level, or; which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year

Description Percentage

Which are nearly constant and restrict routine daily activities to 50 to 75 percent of the pre-illness level, or; which wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year

Description Percentage

Which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level, or; which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year

Description Percentage

Which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or; symptoms controlled by continuous medication


Note: For the purpose of evaluating this disability, incapacitation exists only when a licensed physician prescribes bed rest and treatment.

Note: Rate any residual disability of infection within the appropriate body system as indicated by the notes in the evaluation criteria. As applicable, consider the long-term health effects potentially associated with infectious diseases as listed in §3.317(d) of this chapter, specifically Brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium Tuberculosis, Nontyphoid Salmonella, Shigella, Visceral Leishmaniasis, and West Nile virus.

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