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food poisoning (foodborne disease)

Etiology: 1) pathogenic microorganisms a) bacteria 1] Salmonella (most common) [3] a] seeded vegetables (18%) b] eggs (12%) c] fruit (12%) d] chicken (10%) e] sprouts (8%) f] beef (9%) g] pork (8%) [6] 2] Shigella 3] pathogenic E coli (E coli O157) a] beef (46%) [6] b] vegetable row crops (36%) [6] 4] Vibrio species a] Vibrio cholerae b] Vibrio parahaemolyticus c] Vibrio vulnificus 5] Campylobacter a] unpasteurized milk (66%) [4,6] b] chicken (8%) 6] Listeria monocytogenes a] fruits (50%) [6] b] dairy (31%) [6] 7] Yersinia enterocolitica b) virus - Norwalk virus c) parasites 1] anisakis 2] Giardia lamblia 3] Entamoeba histolytica 4] Cryptosporidium in immunocompromised hosts 2) microbial toxins a) Staphylococcal food poisoning b) Clostridium toxin - cooked meats c) Bacillus cereus toxin - fried rice d) botulism 3) plant toxins a) mushrooms - genus Amanita b) toxalbumin-producing plants - jequirty & rosary bean c) fava beans d) water hemlock e) herbal remedies 4) animal toxins a) scombroid fish poisoning (scombrotoxin may be histamine) 1] tuna 2] mackerel b) neurotoxic seafood poisoning 5) chemicals - monosodium glutamate (MSG) 6) foodborne bioterrorism 7) kitchen towels may harbor pathogens linked to food poisoning [7] Clinical manifestations: 1) nausea/vomiting 2) diarrhea 3) abdominal pain 4) neurologic symptoms Laboratory: 1) stool examination for blood, fecal leukocytes & parasites 2) bacterial culture of stool, emesis, food 3) further examination in high risk patients with neurologic or systemic symptoms or symptoms lasting > 2 days a) Norwalk virus identification by PCR or EM b) toxin testing 1] botulism 2] fish toxins 3] chemicals 4] some bacterial toxins c) acid fast staining for Cryptosporidium Differential diagnosis: 1) gastrointestinal symptoms a) nausea/vomiting, upper GI - incubation < 2 hours - heavy metals - chemicals - mushrooms - incubation 1-7 hours - Staphylococcus aureus - Bacillus cereus - Anisakis - incubation period 8-14 hours - Anisakis - incubation period >14 hours - Norwalk agent b) non-inflammatory diarrhea (no fecal leukocytes) - incubation period 8-14 hours - Clostridium perfringens - Bacillus cereus - incubation period > 14 hours - enterotoxic E coli - Vibrio cholerae - Giardia lamblia - Norwalk agent c) inflammatory diarrhea - incubation time > 14 hours - Salmonella - Shigella - Campylobacter - invasive E coli - Vibrio parahaemolyticus & Vibrio vulnificus - Entamoeba histolytica - Yersinia enterocolitica 2) neurologic symptoms a) incubation time < 2 hours - insecticides - mushroom & other plant toxins - monosodium glutamate (MSG) - shellfish, scombroid b) incubation time 1-7 hours - Ciguatera - shellfish c) incubation time > 14 hours - botulism 3) other symptoms - incubation time > 14 hours - E coli O157:H7 associated hemolytic-uremic syndrome Management: 1) majority of food poisoning is self-limited & therapy is non-specific & supportive - replace gastrointestinal losses with oral or IV fluids - supportive therapy for neurologic manifestations - anti-emetics are contraindicated; induce emesis if it has not already occurred - avoid antiperistaltic agents with inflammatory diarrhea - antibiotics not helpful for S aureus, B cereus, C perfringens, viral gastroenteritis 2) specific therapy for: - botulism - inflammatory bacterial diarrhea - parasitic infections

Related

Bacillus cereus enterotoxin Clostridial enterotoxin Staphylococcal enterotoxin

Specific

azaspiracid botulism foodborne bioterrorism mushroom poisoning scombroid fish poisoning

General

toxicity; poisoning; overdose

References

  1. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1164-65
  2. UpToDate 14.1 http://www.utdol.com
  3. Centers for Disease Control and Prevention (CDC) Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996-2010 MMWR June 10, 2011 / 60(22);749-755 PMID: 21659984 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a5.htm
  4. Mungai EA et al Centers for Disease Control and Prevention (CDC) Increased Outbreaks Associated with Nonpasteurized Milk, United States, 2007-2012 Emerging Infectious Diseases. 21(1) January 2015 http://wwwnc.cdc.gov/eid/article/21/1/14-0447_article
  5. National Antimicrobial Resistance Monitoring System The 2012 NARMS Annual Human Isolates Report CDC NARMS tracks antimicrobial resistance in Salmonella and other enteric (intestinal) bacteria that may cause mild or severe diarrhea or bloodstream infection. http://www.cdc.gov/narms/reports/annual-human-isolates-report-2012.html
  6. Foodborne Illness Source Attribution Estimates for Salmonella, Escherichia coli O157 (E.coli O157), Listeria monocytogenes (Lm), and Campylobacter using Outbreak Surveillance Data. Report. Interagency Food Safety Analytics Collaboration (IFSAC) Project. February 2015 http://www.cdc.gov/foodsafety/pdfs/ifsac-project-report-508c.pdf
  7. Walker M. Pathogens Tied to Food Poisoning Linger on Kitchen Towels. E. coli and more found on towels in Mauritian households even after a month. MedPage Today. June 10, 2018 https://www.medpagetoday.com/meetingcoverage/asmmicrobe/73401 - Biranjia-Hurdoyal S et al Kitchen towel as risk factor for home based food poisoning. ASM Microbe 2018; AES LB-11.
  8. Vearrier D 8 Cases of Food Poisoning: Find the Pathogen Responsible. Medscape. March 22, 2021 https://reference.medscape.com/slideshow/food-poisoning-6009621
  9. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Food Poisoning https://www.niddk.nih.gov/health-information/digestive-diseases/food-poisoning